Scottish Parliament, 6 May 2004

381 contributions from 74 members. The official report.

Introduction

Business Motion

George Reid (None, Ochil)

Good morning. The first item of business is consideration of business motion S2M-1275, in the name of Patricia Ferguson, on behalf of the Parliamentary Bureau, setting out a timetable for the stage 3 consideration of the National Health Service Reform (Scotland) Bill.

Motion moved,

That the Parliament agrees that, during the Stage 3 proceedings of the National Health Service Reform (Scotland) Bill, debate on each part of those proceedings shall be brought to a conclusion by the time-limits indicated (each time-limit being calculated from when Stage 3 begins and excluding any periods when other business is under consideration or when the meeting of the Parliament is suspended or otherwise not in progress):

Groups 1 and 2 - no later than 25 minutes Groups 3 and 4 - no later than 1 hour Groups 5, 6 and 7 - no later than 1 hour 50 minutes Motion to pass the Bill - no later than 2 hours 30 minutes—[Tavish Scott.]

Motion agreed to.

National Health Service Reform (Scotland) Bill: Stage 3

George Reid (None, Ochil)

We now move on to the stage 3 proceedings for the National Health Service Reform (Scotland) Bill. As members know, they should have the bill as amended at stage 2—that is, SP Bill 6A; the marshalled list, which contains all amendments that have been selected for debate; and the groupings.

I will allow a voting period of two minutes for the first division this morning. Thereafter, I will allow a voting period of one minute for the first division after a debate on a group. The voting period for all other divisions will be 30 seconds.

George Reid (None, Ochil)

Amendment 1, in the name of Malcolm Chisholm, is grouped with amendment 6.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

Amendment 1 is a minor technical amendment, or perhaps I should say a very minor technical amendment, as the words that it deletes are reinserted, albeit in a different place.

The error that amendment 1 corrects occurred in the printing of the marshalled list of amendments at stage 2. The amendment affects subsection (2)(a) of proposed new section 4A of the National Health Service (Scotland) Act 1978. That paragraph provides for the general community health partnership function of co-ordinating the planning, development and provision of certain services. In turn, the relevant services are set out in subparagraphs. The effect of the error is that the words

"with a view to improving those services"

are currently attached to subsection (2)(a)(ii), although the intention is that they should apply to all the functions that subsection (2)(a) covers. Amendment 1 ensures that the bill reflects the original policy intention.

I can appreciate what Duncan McNeil is trying to do with amendment 6, and I pay tribute to all the work that he has done on patient information. It is clearly very important that patients and the public should know about the services that they can expect the national health service to deliver and the targets that we have set for the provision of those services. We are committed to ensuring that that information is made available at national and local levels so that patients are comprehensively informed.

We consulted last year on the document "Patient Rights and Responsibilities: A draft for consultation", which sets out what patients can expect from the NHS, and we are currently working with the Scottish Consumer Council to finalise the document. It will be produced as a national document that states what the NHS is committed to deliver to the people of Scotland. We will require each health board to publish a local version of the document, which will show how those rights and responsibilities will be delivered locally. We are already working on, and are committed to, ensuring that patients have information on the services that they can expect to receive. When that local information is issued, we will ensure that it gives the full information that is necessary to inform the public of their rights as well as specific local services and provision that are available. We will also ensure that NHS boards disseminate that information widely in different forms so that it is available to the largest possible number of people locally.

Amendment 6 is not the best way to achieve what we are determined to do, and there are a number of reasons for that. For example, it covers all health services, whereas CHPs' remit will not extend to all health services. If any such duty were to be placed on a body, it would need to be placed on NHS boards, and, as I have already stated, we shall require boards to provide information.

We are committed to reducing waiting times in general and specific waiting times in some key areas of treatment, such as heart surgery. We fully agree that the public need to know which services are subject to waiting times guarantees and how they can ensure that their health board can fulfil those guarantees. The purpose of having a guarantee is to impose a requirement on NHS boards to ensure that the guarantee is fulfilled. If a board cannot itself offer treatment to fulfil a guarantee, it is required to arrange and fund treatment through another health board or through an alternative public or private provider in the United Kingdom or elsewhere. That reflects our absolute commitment to ensuring that guarantees are fulfilled.

If patients have any difficulty in obtaining access to treatment that should be available under a waiting times guarantee, that will be followed up in the first instance with their local health boards and then with the national waiting times unit in the Health Department, which is working with the NHS in Scotland to reduce delays for patients through more efficient use of capacity within and outwith the NHS and to help to ensure that waiting times guarantee commitments are fulfilled. The national waiting times unit will then ensure that a provider that is able to offer treatment is identified and that the necessary arrangements for treatment are completed through the local health board.

I am happy to provide the assurance that the commitments to waiting times guarantees will be set out in the patient information documents that we will issue nationally and locally and that that will include information on what patients should do if they feel that they are not receiving treatment within the guaranteed waiting times. Duncan McNeil might say that that has not happened yet, but I remind members that the guarantees started only this January, and I give another guarantee that the information that I have described will be disseminated nationally and locally in the near future. That is the most effective way to ensure that patients know which treatments are subject to targets and the rights that they have to ensure that those targets are hit.

I move amendment 1.

Duncan McNeil (Labour, Greenock and Inverclyde)

I will make some brief statements of fact. The more socially disadvantaged and less well-educated members of our communities have the poorest health and shortest life expectancy. Our constituents, especially the more socially disadvantaged and less well-educated, are not conversant with their rights to NHS treatment. It is not possible for somebody to exercise a right if they do not know that it exists, and a right that cannot be exercised is no right at all.

Amendment 6 seeks to put right that situation by placing a statutory duty on community health partnerships to take active steps to make the public aware of what they are entitled to, the timescale within which that should be provided and which alternative sources of treatment they can access in the event that the service cannot be delivered within the timescales. The amendment would also place a duty on CHPs to ensure that access to that information is as wide as possible. It would require that the information be made available in a range of formats—for example, Braille and languages other than English.

With amendment 6, I am determined to improve the health record of our most deprived communities and to close the opportunity gap, and so I am sure that I can count on Executive support for such a modest move.

David Davidson (Conservative, North East Scotland)

I accept the minister's explanation of amendment 1 and I have great sympathy with what Duncan McNeil is trying to do with amendment 6. It is important that we stress at the beginning of the debate that the patient should be at the centre of the health service, not added on to it. We should do anything that we can to provide patients with the right information. We hear a lot of groups talking about patient empowerment, and I have great sympathy with what Duncan McNeil has said, so I do not understand why the minister wants to produce expensive, glossy documents for national distribution given that when people have difficulties, they seek local health care in their communities. I beg the minister to change his mind about Duncan McNeil's amendment 6, which I will certainly support.

Karen Gillon (Labour, Clydesdale)

I am generally sympathetic to Duncan McNeil's amendment 6, because it is essential that patients should know what they are entitled to. I welcome the minister's comments, which are a step forward from the position at stage 2, but I would like more information from him about what he proposes and how he will ensure that that will reach the targets—the kind of people about whom Duncan McNeil is talking—and will not be just another glossy pamphlet that reaches only those who already know their entitlement, stand up for their rights and ensure that they get their treatment within the waiting times guarantees. How will he ensure that the people whom we are trying to target—those who have the worst health records and who might not read a glossy pamphlet—know what they are entitled to, what they should do to obtain that entitlement and the steps that they can take if a health board stands in the way of their accessing the health care that we in the Labour Party were committed to in our manifesto and are beginning to deliver?

Jean Turner (Independent, Strathkelvin and Bearsden)

I support Duncan McNeil's amendment 6. General practitioners are used to giving patients information and to making patient leaflets that are updated with changes and contain maps. GPs' staff also help them to convey information.

Glossy leaflets are not enough. They are often found lying around health centres, where people may walk on them. They are just waste paper to gather at the edges of fences.

The Health Department frequently employs much cash to convey information to the public. Sometimes, £85,000 is not considered too much to spend on one publication.

Providing information is health boards' responsibility, as they are supposed to interact with the public and communicate information. If they are to place more responsibility on general practitioners, they must think about the money and time that will be spent on producing materials, such as posters and leaflets, in addition to postage and staff costs.

Given the new regulations that will mean that not all practices have to provide the same service, it is essential that patients have knowledge. A patient's own general practice is a good place of contact. Greater use of health visitors would also enable information to circulate in the community.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Duncan McNeil's objective is good and perfectly achievable. The only question is whether it should appear in the bill. We are establishing community health partnerships by giving them aims and objectives and specifying the practices that they must undertake. Duncan McNeil is arguing for good practice—it is good practice that patients should receive such information. However, I am not convinced that it is necessary to put that in legislation and I urge him not to move amendment 6, because it would not be helpful to make such provision when we have not yet established the CHPs.

Shona Robison (Scottish National Party, Dundee East)

I support Duncan McNeil's amendment 6, which is reasonable. I remind members that it says that "all reasonable steps" should be taken

"to provide information, in such formats as may be reasonably requested ... about ... the health services to which"

people

"are entitled ... the timescales within which such services will be provided, and ... any alternative sources of treatment which they are entitled to access in the event that such a service cannot be delivered within such a timescale".

I do not understand why the minister is reluctant to accept the amendment. People should be fully informed and should receive information in a format that they understand. That is not too much to ask from our health service.

In answer to Mike Rumbles's question, the reason for putting the provision in the bill is simple: it would state from the start the principle of what we expect from the new bodies that are being established. That would send out the right message about what we expect from community health partnerships. I hope that the minister will reflect on that and accept Duncan McNeil's amendment.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I agree with almost everything that has been said, but I do not draw the conclusion that it is therefore appropriate to put in the bill a duty on community health partnerships, which are new bodies that will already have massive responsibilities and challenges.

My fundamental point is the same as that which Jean Turner made. She said that she supported Duncan McNeil's amendment 6 but that providing information was the health boards' responsibility, which is the fundamental point that I made. Community health partnerships are committees of boards, so they will obviously have a key role to play, but the fundamental duty is on health boards. As I described in detail, we shall ensure that boards fulfil that responsibility.

I agree entirely with Duncan McNeil that people cannot exercise rights if they do not know that those rights exist. That is precisely why we are working with the Scottish Consumer Council on finalising a statement of patient rights and responsibilities. I assure him that that will be available in a range of formats.

Of course I agree with David Davidson that patients should be at the centre of the health service, but I am again astounded that he should imply that we think otherwise. As he thinks in stereotypes about the Executive's health policy and does not pay attention to what we are doing, he talked about national distribution and blotted out all my remarks about the information that would be available locally. The thrust of what I said was that information would be in local formats.

I agree with Karen Gillon that it is essential that patients should know their rights. She asked how we would ensure that the target was hit. To do that, we will not only produce the new document to which I referred, but ensure that boards disseminate that information, as I outlined. The reality is that the way in which we will ensure that that happens will not be fundamentally different from the way in which Duncan McNeil's amendment would be enforced. If his amendment were agreed to, we would have to ensure that community health partnerships provided information, just as we will ensure that boards fulfil that responsibility. In many cases, boards will act through community health partnerships to do that.

I dealt with Jean Turner's comments and I thank her for saying that providing information is the health boards' responsibility. I do not disagree with Shona Robison that all reasonable steps should be taken to provide information. I certainly agree that that should be done—I might even want to state it more strongly than that.

I implore members to accept that the primary responsibility must be on the health boards. Community health partnerships could be the most exciting part of the bill. They have enormous challenges. To place on them alone the duty to provide information, which would have quite a lot of ramifications, and to do so without consultation—although a massive consultation document on the partnerships was issued—would be received extremely negatively by those who are involved in the partnerships. It is not that they do not want to be part of fulfilling the responsibility, but I repeat that the primary responsibility rests with health boards. We shall ensure that they discharge it.

Amendment 1 agreed to.

[Amendment 6 moved—[Mr Duncan McNeil].]

George Reid (None, Ochil)

The question is, that amendment 6 be agreed to. Are we agreed?

George Reid (None, Ochil)

There will be a division.

George Reid (None, Ochil)

The result of the division is: For 38, Against 57, Abstentions 5.

Amendment 6 disagreed to.

George Reid (None, Ochil)

Group 2 is on equal opportunities. Amendment 2 is grouped with amendment 5.

Tom McCabe (Labour, Hamilton South)

At stage 2, the Executive lodged an amendment to provide a legal underpinning to the existing policy of encouraging health boards, special health boards and the Common Services Agency to discharge their functions in a manner that encourages equal opportunities. The duty, as introduced at stage 2, will require those bodies to encourage equal opportunities and to observe equal opportunities requirements that are contained in existing legislation pertaining to equal opportunities. The duty applies to the functions of those bodies that arise from the National Health Service (Scotland) Act 1978.

The amendments extend the duty to promote equal opportunities to all health board, special health board and Common Services Agency functions, not only those that are listed in the 1978 act. Amendment 2 will extend the range of functions to which the duty to promote equal opportunities applies. Amendment 5 is a consequence of amendment 2 and will repeal the duty to promote equal opportunities in the Mental Health (Care and Treatment) (Scotland) Act 2003. That is required in order to avoid unnecessary and potentially confusing duplication.

The issue has been discussed in the NHS, patient bodies and equality bodies and the measures are widely welcomed and supported.

I move amendment 2.

Amendment 2 agreed to.

George Reid (None, Ochil)

Group 3 is on waiting times, the duty to provide goods and services and national tariffs. Amendment 9 is grouped with amendments 10, 21, 22 and 11. There will be a slight pause until Mr McNeil is ready.

Duncan McNeil (Labour, Greenock and Inverclyde)

I apologise for the delay, Presiding Officer.

The partnership agreement pledges that the interests of the patient "will always come first." Sadly, I am not sure whether our communities agree that that happens. When health bosses sit down to consider the most controversial issue that faces the national health service in Scotland—service redesign—they have certain legally binding obligations. There are, for example, the European working time regulations and the new consultant contract. In fact, there is some sort of statutory protection for everyone's interests, except those of the patient. The interests of the patient get a look in only when the four corners of the debate, as defined by law, are agreed, and that cannot be correct.

Amendments 9, 10 and 11 seek to redress the balance and give patients' interests parity with professionals' interests. Amendment 9 would give ministers the right, through regulations, to set legally binding guarantees for patients on maximum waiting times for certain services. Amendment 10 would give health boards, in partnership, a duty to ensure adherence to those waiting times guarantees throughout Scotland, and amendment 11 would mean that the powers of intervention in the bill would apply to bodies that, or persons who, do not comply with the waiting time regulations. I do not pretend that the amendments in themselves will put patients at the heart of the national health service, or even the decision-making process—they would simply give patients' interests the same status as those of the professionals.

I know from our discussions on the matter that the minister argues that what we currently have is better than what the amendments would deliver and that making maximum waiting times legally enforceable would lead to less ambitious targets being set. However, I do not follow that logic. If we really are already delivering on our tough targets, does the sanction for failure make a great deal of difference? If health boards are not meeting the guarantees, however, the option of recourse to the legal system would put the power to take action in the hands of the patient rather than in the hands of the bureaucrats at the national waiting times unit.

On the other hand, boards may have been relying on the public's lack of knowledge in order to meet their targets and they would be under real pressure if more patients knew their rights—as amendment 6 would have ensured—and were better able to exercise them. Whatever the case, I cannot see how what is proposed would be detrimental to the people whom I was elected to represent.

I move amendments 9 and 10.

George Reid (None, Ochil)

For the purposes of the Official Report , I advise that, for procedural reasons, although Mr McNeil has spoken to amendments 10 and 11, he can move only amendment 9.

Duncan McNeil (Labour, Greenock and Inverclyde)

Yes. I am sorry.

David Davidson (Conservative, North East Scotland)

Throughout the discussion on regulations, the minister talked a lot about the duties of boards. However, we hear time and again about individuals who cannot get treatment locally at an appropriate stage and about their clinical advisers—whether they are out-patient consultants or GPs—wanting them to receive, on time, treatment that is suitable and which meets the needs of their particular case. In other words, a clinical decision is involved. If the local health board cannot supply a service at a time that the physician recommends, the system should be allowed to change to ensure that the health board facilitates the patient being taken to another health board area—or another source—to receive treatment.

The Minister for Health and Community Care already said at stage 2 that he will put a duty of care on boards to look after other boards' patients. Quite a mix-up is involved in the fund flows and in the understanding of the matter out there. With amendment 21, I seek to put clear reasons in the bill for that approach and to give support to patients in their patient journey, to which the minister frequently refers.

One issue that health boards have raised time and again is that when they have co-operated with another health board, they often get their own operation into financial difficulties—whether through the Arbuthnott formula or something else. They find that they must pay for treatment that has been provided by another board, although the funds do not necessarily follow. To avoid any connivance, in a sense, whereby a board thinks that it can get a service cheaper elsewhere, amendment 22 seeks to set up a national tariff system for NHS treatments that would be set in place by regulation and which could be updated quite simply in the same way that, in pharmaceutical supply, the drug tariff is updated on a weekly to monthly basis.

We must ensure that money timeously follows the patient and does not cause any hold-up in or damage to the system. We should have a national health service, and patients should have the right to transfer within that service. If, as the minister has said, the health service cannot supply a service, the patient should be able to obtain it elsewhere, whether in the independent sector, the voluntary sector or the not-for-profit sector.

All that I seek to do is to put in the bill the rights of patients to have their treatment at the appropriate time wherever their clinicians think that they should have it and wherever it can be dealt with accurately, properly and safely. I want funding to follow the patient. The patient is the core of the health service and every patient journey must have such rights attached to it.

Mr McNeil's proposals are unnecessary. I do not want yet more administrative effort and duties to be placed on health boards when they should be seeking to provide the best possible service at the earliest possible opportunity. The proposals would simply mean a cumbersome administrative exercise.

I move amendments 21 and 22.

George Reid (None, Ochil)

Mr Davidson can only speak to amendments 21 and 22; the opportunity to move or not to move them will come later.

Shona Robison (Scottish National Party, Dundee East)

I support amendment 9, in the name of Duncan McNeil. We should be prepared to take the step that he proposes for a number of reasons, the most important of which is that, currently, a number of health boards are under considerable financial pressure. We are concerned that that could lead to an erosion of the waiting times guarantee. We know that health boards are under pressure and that, in some areas, waiting times will be impacted on. Giving patients the right to recourse if health boards fail to meet the waiting times guarantee would prevent that happening.

Duncan McNeil made a strong case when he spoke about the patients' interests being protected in the same way that others' are. At present, the public and patients feel that the health service is not always run in their interests and that is a perception that we all want to change.

Accepting amendment 9 would send out a strong message to health boards that failure to fulfil their duty to patients would empower the patient to use the law to get what they should be getting from the health board in their area. I am happy to support Duncan McNeil's amendment 9.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I will not comment on the dispute between Duncan McNeil and the minister about Duncan McNeil's amendments; I will stick strictly to David Davidson's amendments.

David Davidson gives the appearance of being the patients' champion in the national health service, but he is the champion of the private patient. Liberal Democrats believe that it is healthy to have an alternative to the state-provided health service, but we believe vehemently that the public health service should not be used to subsidise private health care. Amendment 22 would be a passport out of the national health service.

David Davidson has lodged a substantial amendment that strikes at the very principles of the national health service and at the principles of the bill. He did not lodge the amendment at stage 2 in committee—in fact, David Davidson signed up to the Health Committee's stage 1 report. It was only when that report was debated in the chamber at stage 1 that David Davidson turned about to oppose it.

It is disappointing that amendment 22 has been lodged in this way because the point of the process of passing laws in the Scottish Parliament, which is so different from how it happens in Westminster, is that we involve the public. We involve everybody in the consultation process and take evidence as we go through the process. Lodging amendment 22 at the last possible moment represents Conservative party political principles—it is not appropriate at this stage. I do not question David Davidson's right to do that—he is perfectly entitled to lodge amendments in that way—but it is a little disingenuous of him to pose as the champion of the patient when he is the champion of the private patient.

Carolyn Leckie (SSP, Central Scotland)

I do not disagree that Duncan McNeil has the patient's interests at heart. He spoke about reorganisations in health boards and their lack of accountability, but his amendments do not address that point.

The experience of medical secretaries, for example, is that the management of waiting times distorts clinical priorities and wastes their time in some areas because it takes them away from being able to deliver patient care. Legislating on the matter would be a simplification of the delivery of health care and would risk distorting clinical priorities.

I support Shona Robison's proposed measures to keep health councils and thereby the democratic accountability of health boards. I hope that Duncan McNeil will support those measures because they would provide a way of holding health boards to account for organisations that the public do not support.

I concur with Mike Rumbles on David Davidson's amendments. Instead of allowing the bill to abolish the internal market and trusts, amendment 22 would have the effect of making the internal market that wee bit bigger and it would offer up opportunities for the proliferation of the private sector. David Davidson's amendments are a bit sneaky—I say well done for trying, but we will not support them.

Karen Gillon (Labour, Clydesdale)

I will not support David Davidson's amendments. It is good to have somebody like David Davidson in the Scottish Parliament because it reminds me of why I am in the Labour Party, why the Tories are the Tories and why we must do everything that we can to stop them getting into power at the next general election.

I support Duncan McNeil's amendments. If the waiting times guarantee is to be meaningful, it must be enforceable. I am interested to know why the minister opposed those amendments and why he does not think that a patient should have the right to enforce the guarantee if it is not met by the health board. That was a key plank of our manifesto and many people voted for us on that basis, so I would be grateful to know why they should not have that right.

There will be pressures on health boards and, in my area, we have been made aware of a couple of pressures in relation to how the consultant contract will impact on elective surgery. I would be grateful to know from the minister how we can continue to meet those guarantees without giving patients the right to recourse when we fail to meet them.

Christine Grahame (Scottish National Party, South of Scotland)

I rise in support of Duncan McNeil's amendments and against David Davidson's amendments. Many of the arguments have already been made; I simply endorse Duncan McNeil's amendments. We are not dealing with a simple matter of providing information—it is also about having equality throughout Scotland. The key is that we want to embody the waiting times guarantee in regulations to make it legally enforceable. That is what the minister does not want to face—he does not want to deal with litigation based on the regulations. However, it is important to have them because there is no point in having a waiting times guarantee if it is just a piece of paper that one can do nothing about.

Much has been said about David Davidson's amendments. I say more kindly than Miss Leckie, with whom I agree entirely, that the amendments represent an unsubtle attempt to take us incrementally down the road of Tory privatisation. We know that some health services have already been purchased outside the NHS, but the Scottish National Party does not want to see that increase—we would like to see a return to a much more public service. David Davidson's amendments are unsubtle and will be rejected by the Scottish National Party.

Jean Turner (Independent, Strathkelvin and Bearsden)

I have the joy of being an independent member and I do not feel obliged to vote one way or the other on the amendments—I agree with them all. I agree with Duncan McNeil because what he said was important.

I know what happens to patients and when I looked at David Davidson's amendments, I thought about the passports that everybody is afraid of. I hate to think that the national health service would ever be privatised, but I tell members that, in Glasgow, there are three different prices for orthopaedic operations. There is a price for the health board, there is a different price for the Golden Jubilee hospital, which might be the cheapest, and there is another price for the private sector. So many people out there are in desperate need of a hip replacement operation to keep them mobile that, as I have said before in the chamber, they have had to spend their hard-earned savings on having perhaps two hip replacements. They receive no tax rebate although they have paid into the national health service, which cannot provide.

One of my constituents would love to go anywhere in Scotland to have his hip replaced, but he has not been able to have that sorted out. I had a patient at the Glasgow royal infirmary, but when his consultant was transferred to the Golden Jubilee hospital, the whole waiting list did not move with that orthopaedic surgeon to the new hospital. My patient was deprived of having his operation in time. I should have said constituent rather than patient—I still forget that I am no longer a general practitioner. That poor chap would dearly have loved to go private because there was no other way for him to have his operation in time. He would have scraped up the money—his family would have provided the finances—but he was not fit to have his operation done in the private sector. We should remember that it is not always easy to choose to use the private sector. It might be imperative to stay in the NHS and in an NHS general hospital because of one's other medical conditions.

I read David Davidson's amendments carefully and, if he has some ulterior motive, I am sorry about that. I agree with what he says, however, because I would like equality and I would like patients to have their treatment now.

Far too many people are having to wait. For example, I know someone who has to wait 72 weeks for her first orthopaedic appointment in an NHS hospital. The NHS is not working. The waiting times are dreadful. In fact, consultants do not know the real extent of the waiting lists; instead, they are given what they are told is their waiting list, although they know that the rest of their list is sitting in some other part of the hospital. As a result, any suggestions on how we can keep an eye on waiting times would be valuable. Targets are another matter: I would ban them. In any case, I agree with all the members who have spoken.

I remind members—

George Reid (None, Ochil)

Briefly, please.

Jean Turner (Independent, Strathkelvin and Bearsden)

I will be very brief. I remind members that people in the outer Hebrides are able to receive physiotherapy the next day, the day after that or the next week whereas people in Glasgow have to wait 13 weeks for the same treatment. As patients within the health service do not have an equal opportunity, I support all the amendments that have been lodged in this group. Lucky me.

John Swinburne (SSCUP, Central Scotland)

In many cases, we are talking about pain. Someone who is in pain will take any steps to alleviate it. I am a great supporter of and believer in the NHS. As the service already allows consultants to carry out private work, I do not see that there is a great deal of difference between David Davidson's proposals and the Executive's position.

I do not believe in private medicine, but neither do I believe in private pain. I was forced to have an operation privately, because I could not suffer the pain of my arthritic hips for another year. My heart goes out to anyone who is still waiting in that queue for treatment.

I support the amendments lodged by Duncan McNeil and David Davidson. As Jean Turner said, they are both right, and consensus on this matter would help everyone.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I appreciate the intention behind amendments 9, 10 and 11 and assure Duncan McNeil and Karen Gillon that the patient guarantees will be met. That said, I am not convinced that those three amendments will achieve the desired outcome or be in patients' interests.

To date, we have made some good progress in working with health boards to reduce waiting times and to ensure that the guarantee is delivered. I should remind members that the guarantee itself kicked in only this year. I accept Dr Jean Turner's comments about out-patient waiting times, which were left for too long in Scotland. However, we are very much making up for that now by introducing a major programme of work on reducing out-patient waits. Indeed, I am speaking tomorrow at a major out-patient event for one of the areas affected—ear, nose and throat—and will announce some money and ensure that action is taken to reduce those waits.

Progress has been helped by the work of the centre for change and innovation and the waiting times unit and by making available the resources of the Golden Jubilee national hospital to NHS patients across Scotland. I believe that that collaborative approach has achieved results and is more constructive than the legal approach that is proposed in amendments 9, 10 and 11. As I pointed out in relation to amendment 6, steps are being taken to ensure that patients are well aware of the waiting time guarantees; what the waiting times are; and what they should do if they feel that the guarantee has not been met in their case.

I have three general objections to the idea of enshrining maximum waiting times in primary legislation.

Christine Grahame (Scottish National Party, South of Scotland)

Will the minister give way?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I will take an intervention after I make my three points.

First, creating legal duties in relation to services that are subject to a waiting time guarantee—including elective surgery such as hernia repairs and cataract removal—would give rise to a perverse situation in which those services could become a priority over other more clinically urgent services—such as emergency services—that are not enshrined in legislation in such a way. Indeed, I think that Carolyn Leckie made the same point. It would mean that boards would be under express legal duties in relation to services covered by the waiting times guarantee, but not under similar duties for other services such as emergency care.

Secondly, as waiting times are integral to the quality of the services provided, I do not think that it is appropriate to single out in legislation the particular issue of waiting times from other crucial aspects of quality.

Thirdly, our firm guarantees already go beyond what applies in the rest of the UK. Turning those guarantees into a legal duty could be counterproductive in creating pressure to soften targets and guarantees as a result of the potential for expensive legal challenges against boards. Even if Duncan McNeil does not accept that that might be a possibility, I hope that he thinks it reasonable to give the guarantees some time to prove themselves. After all, as I have said, they were introduced only in January.

Christine Grahame (Scottish National Party, South of Scotland)

I think that the minister has already answered my question. However, for the sake of clarity, is he saying that the waiting time guarantee is not legally enforceable and that, if it were not met in my case, I could not take him, his department or any board to court?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

That is a statement of fact. However, I have already assured members that the guarantees will be met and there are many ways of ensuring that that happens short of putting them in primary legislation. I certainly think that many staff members and patients would be horrified at the idea that someone in such a situation should be taken to court. My point is that, if we push this provision beyond a guarantee, we will create a perverse situation in which minor elective procedures, which would then be legally binding, would have to be put before emergency care, which would not be. Such a situation would be neither clinically acceptable nor in patients' interests.

The other duties set out in amendments 9 and 10 do not add anything to the current arrangements. As the duty in section 12H of the National Health Service (Scotland) Act 1978 currently requires arrangements for monitoring and improving the quality of health care to be in place, it already applies to waiting times because that aspect of a service is an integral part of the service's quality. As a result, systems already exist for monitoring and reducing waiting times. For example, boards make regular submissions to the department's waiting times unit on how they are performing against the waiting time targets. Given that the 1978 act contains such an equivalent duty, amendment 9 is therefore unnecessary.

Amendment 10 seeks to affect the duty of co-operation. However, as currently drafted, the bill already requires boards to

"co-operate ... with a view to securing and advancing the health of the people of Scotland".

That wording already covers co-operation to reduce waiting times as that itself would advance

"the health of the people of Scotland".

Boards will continue to co-operate with the Golden Jubilee hospital on reducing waiting times and will also work with other health boards in a national effort to reduce them.

On amendment 11, I agree that if a board is systematically failing to meet waiting times targets it might be necessary as a last resort to use the new power of intervention. That is partly a response to Christine Grahame's earlier point. Such boards would clearly be failing to provide the service to a standard that Scottish ministers find acceptable.

That does not mean that I support amendment 11. It is unnecessary because, as drafted, the power of intervention already allows ministers to intervene when an adequate service is not being provided. I have said before that we will not be able to prescribe every circumstance in which Scottish ministers should intervene and waiting times should not be singled out over and above other issues such as quality. That issue will no doubt arise when we discuss the next group of amendments.

Moving on to David Davidson's amendments, I have to say that amendment 21 is quite unusual in how it takes the good aspects of the current service and makes them worse. At present, a patient has a consultation with a medical practitioner, who then decides on the treatment that the patient needs. Taking into account the seriousness or urgency of the patient's condition and the availability of services, the medical practitioner will then consider where the patient can receive that treatment and make a referral for specialist services on that basis.

The national waiting times database has been available to all GPs since December 2002 and to the public since October 2003. It is designed to help and support patient choice and to inform decision making for the patient, the primary care practitioner and hospital services. If the patient and general practitioner want a referral to a clinic in another board area, that can already happen.

David Davidson (Conservative, North East Scotland)

The minister mentioned patient choice. I am trying to ensure that such choice can be delivered on the ground and that there are clearer duties in that respect. It should not simply be put into the melting pot of waiting times. Recently, a constituent of mine had a lump in her breast and was panic-stricken. She went to her general practitioner and he asked for an immediate investigation, but the health board said that it did not have the capacity to do that within two months. She went for private treatment. She did not have health insurance but she and her family scraped the money together. Is it not right that, if a health board cannot provide the service, a patient can be referred elsewhere? We are certainly not proposing the privatisation of the health service, but if the health service fails, there should be provision for other services to provide the treatment. It is concern for the treatment of the patient that lies behind amendments 21 and 22.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The reality is that, under the arrangements that I have just described, that constituent could have been referred to another board if the waiting time had been shorter there. The problem with amendment 21 is that it would seriously distort priorities at health board level because decisions on the timing of treatment would rest solely with individual medical practitioners, as stated in the proposed new subsection (2C). If anyone is thinking of supporting amendment 21, I ask them to read the proposed subsection (2C) within it, which makes it clear that a letter from a GP would supersede not only the targets and the waiting times guarantee but clinical priority as well.

Amendment 21 says that a medical practitioner could insist on the precise time of treatment. That could lead to a scenario in which a GP demanded that a minor surgical procedure be performed quickly, with the result that a far more serious operation had to wait longer. Different practitioners would make different professional judgments in situations that might seem similar to us. However, amendment 21 would place a legal duty on a health board to do whatever an individual doctor said that it must do. The board would have to ensure that a service was provided to the individual patient by a date dictated by the doctor. The health board would not be able to consider the disruption to other treatment, to consider wider priorities, or to consider other strategic matters. I fail to see how that would be good for patients or the NHS.

I turn now to amendment 22. The tariff idea is interesting. David Davidson has lifted it from Labour in England—albeit with a deadly Tory twist. The idea of having a uniform cost for a particular treatment is one in which I am interested. I have asked my department to give it detailed consideration. However, it would be quite wrong to agree to amendment 22 on the hoof without such detailed consideration and without consultation. For example, one of the down sides to the idea may be that treatments cost different amounts in different hospitals for quite legitimate reasons. It may well be that small hospitals would lose out under such a system.

The Tories support this idea as a Trojan horse for their unfair and divisive patient passport, whereby each patient would automatically receive a tariff—or "part of the tariff", to use the very words of the proposed section 17J(c)(ii) in amendment 22—in order that those who can afford it can supplement their own private payment and access health care on the basis of income rather than on the basis of clinical priority.

George Reid (None, Ochil)

Minister, we have only nine minutes in which to get through both this group of amendments and the next group, before the knife falls at 10:31.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

That is utterly unacceptable and is—[ Laughter. ]

I mean, David Davidson's amendment 22 is utterly unacceptable. [Laughter.] No, actually, I meant that the Tory twist was utterly unacceptable. [Laughter.] In itself, that twist is sufficient reason to reject amendment 22.

George Reid (None, Ochil)

Mr McNeil, do you wish to wind up briefly?

Duncan McNeil (Labour, Greenock and Inverclyde)

No. I have heard what the minister said and I am happy with that.

George Reid (None, Ochil)

Are you pressing amendment 9?

Duncan McNeil (Labour, Greenock and Inverclyde)

No, I am not.

Amendment 9, by agreement, withdrawn.

George Reid (None, Ochil)

The question is, that amendment 21 be agreed to. Are we agreed?

George Reid (None, Ochil)

There will be a division.

George Reid (None, Ochil)

The result of the division is: For 15, Against 89, Abstentions 0.

Amendment 21 disagreed to.

George Reid (None, Ochil)

The question is, that amendment 22 be agreed to. Are we agreed?

George Reid (None, Ochil)

There will be a division.

George Reid (None, Ochil)

The result of the division is: For 16, Against 88, Abstentions 0.

Amendment 22 disagreed to.

George Reid (None, Ochil)

Amendment 3 is in a group on its own.

Tom McCabe (Labour, Hamilton South)

Amendment 3 serves two main purposes. The first relates to the range of individuals who may be included within an intervention team that is to be sent into a health board to bring a failing service back to an acceptable standard. The bill currently restricts the individuals who are eligible for an intervention team to employees from health boards, special health boards, the Common Services Agency and the Scottish Executive. It is considered that local authority employees could usefully be added to this list, thereby broadening the pool of expertise and experience that Scottish Ministers could draw from. The first part of the amendment gives effect to that policy.

The second reason for amendment 3 is to clarify that the actings of the appointed person are to be treated as actings of the relevant body that is subject to the intervention. As I said during stage 1, the general principle to which we are working is that boards that are responsible for a failing service should be responsible for the costs of intervention to remedy the failure. The alternative would be for costs to fall on the entire Scottish NHS budget and therefore on boards as a whole. We believe that it would be wrong to penalise other boards for the costs of correcting the failings of one board. However, the amendment also enables Scottish ministers to assist with the costs of the intervention if they choose to do so. For example, if ministers were to take the view that the costs were such that, if the board was to meet them, it would result in a material reduction in services in that board area, they could decide that it would be appropriate for the Executive to contribute to, or bear, the costs of remedying the failure. The effect of doing so would, of course, be to spread the costs across the whole of Scotland. Amendment 3 also makes it clear that third parties do not have to distinguish between acts of the relevant board and those of the appointed person in the unlikely event that they suffer any loss during the course of an intervention.

I hope that I have provided the necessary clarification that the Health Committee requested at stage 1.

I move amendment 3.

Murray Tosh (Conservative, West of Scotland)

We have very little time. I call Shona Robison.

Shona Robison (Scottish National Party, Dundee East)

The minister will be aware that there have been concerns about who meets the costs of interventions. The Health Committee had a lot to say about that because we are talking about health boards that are already under severe financial stress. I am pleased that the minister has said that, when the costs would lead to a material reduction in services, the Executive could help to meet those costs. That is to be welcomed. However, we require a bit more information about what would constitute a material reduction in services. At what level would that be measured? How would it be assessed whether services had been reduced to that extent? It would be helpful to have more information on that.

Murray Tosh (Conservative, West of Scotland)

I apologise to the two members whom I cannot call.

Tom McCabe (Labour, Hamilton South)

It is clear that the Executive would want to take action to ensure that there was a comprehensive assessment of the situation in any area. The criterion is that, regardless of what has occasioned the failure of a service within a board, whatever actions we take should not have a detrimental effect on the other services within that area. The Scottish Executive, aided and abetted by the officials who serve us, would conduct a comprehensive assessment to ensure that we did not take any action that would have further detrimental effects on the people who depended on the services in that area.

Amendment 3 agreed to.

Murray Tosh (Conservative, West of Scotland)

Group 5 is on the membership of health boards. Amendment 12, in the name of Shona Robison, is in a group on its own.

Shona Robison (Scottish National Party, Dundee East)

Amendment 12 is necessary because we cannot have a debate on NHS reform without talking about one of the most important reforms that could and should take place in the health service, which is to redress the balance by tackling the lack of public say in and power over the decisions that are made locally about people's health services. We know from all our patches that the public in constituencies throughout Scotland feel dislocated from the decisions that are made by health boards. In Caithness, the west of Scotland, Glasgow or wherever, there are feelings of disempowerment and a sense that the health boards will do what they want to do in spite of the public's opposition.

If we are to address that concern, the public will be able to regain their trust in health boards only if they are given a direct say in the decisions that health boards make. In my opinion, the only way in which to do that is to have direct elections for at least half the places on health boards. I am aware that Bill Butler has made a proposal for a bill on the subject and I look forward to hearing about what is happening on that front and what the timescales are for the bill's introduction. We cannot afford to wait for such change forever. The time is now right to send out a signal to the public that we recognise their disillusionment with the decisions that have been made and so we are prepared to take real action to address the imbalance of power.

I move amendment 12.

David Davidson (Conservative, North East Scotland)

We will not be supporting amendment 12, for the reasons that I stated during stage 2 consideration. The proposal has a huge cost implication and we have far too many elections in Scotland as it is. Frankly, the introduction of elections for health boards would open up the boards to the risk of being taken over by single-issue campaign groups, which could bring nothing but disruption to the running of the boards.

We must seek ways of incorporating health patients' views to a greater extent in the health system. I felt that local health councils played a valuable role in that regard, before the bill came along. There is a big skills gap among the general public about how health boards are run. It is one thing to talk about patients' input and getting their voices heard—I have some sympathy with what Shona Robison said about the needs of communities in relation to consultation on changes such as the centralisation of maternity services—but I do not believe that having an electoral process, which could be repeated time and again during a session of Parliament, to deal with a single issue would be in the interests of the health service's efficiency.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I do not think that Shona Robison seriously expects the Parliament to support her amendments today. I will make the same comment that I made on David Davidson's amendments 21 and 22, which I said would change the NHS's entire principles.

Shona Robison has already referred to Bill Butler's proposal for a member's bill. I am sympathetic towards the principle behind amendment 12, which also lies behind Bill Butler's proposed bill. However, there are two ways of ensuring health boards' accountability to patients and the public. The first is through ministerial powers of intervention and the other is through direct elections. I am sympathetic towards direct elections because, when the National Parks (Scotland) Bill was considered by the Rural Affairs Committee in the first parliamentary session, I lodged 15 amendments on the subject. They were successful—the Parliament agreed to them—and 20 per cent of all the members of the national parks boards are now directly elected by the people within the national park boundaries. That is a good thing and, from speaking to the people who are involved, I believe that the system works extremely well.

I am supportive of the principle, but I return to the point that I have just made. There are two public accountability options—direct elections and ministerial intervention. Although I am supportive of the Executive's decision to go down the route of ministerial intervention, it presents me with a difficulty. How compatible with direct elections is giving the minister powers to intervene to ensure the public interest, if that means that the people who are directly elected are then subject to ministerial intervention? That is the crux of the matter. Members of all parties who want health boards to have more public accountability face a real dilemma.

On amendment 12 specifically, I do not think that now is the moment for the Parliament to take on board Shona Robison's proposal without a thorough investigation. We must give due attention to Bill Butler's proposed bill.

Janis Hughes (Labour, Glasgow Rutherglen)

I support the spirit of amendment 12, which is the same as an amendment that Shona Robison lodged at stage 2. I accept that the proposal forms an important part of reform of the NHS and links in with a number of other areas that are dealt with in the bill, such as consultation.

I fully agree that the public should have a say, through consultation, in how services are delivered in their area, but I also believe that they should have a say on the question of direct elections to health boards. That is why I think that it is premature to lodge such an amendment. Mention has already been made of making policy on the hoof and I think that that is what we would be doing by including in the bill provision for direct elections to health boards.

I have given my support to Bill Butler's proposed member's bill and I think that the way forward is through full consultation, which I understand will be happening in the near future. Through such consultation, we should give the public the opportunity to comment on how they view direct elections to health boards. For that reason, I will oppose amendment 12.

Carolyn Leckie (SSP, Central Scotland)

I support amendment 12, having lodged a similar amendment. It is unfortunate that such a measure was not contained in the consultation on the bill, as that would have provided the opportunity for it to be discussed fully. I, too, would like there to be a lot more debate about the composition of, and elections to, health boards. I have already indicated my support for Bill Butler's proposed bill.

I will explain why direct elections to health boards are necessary. Up and down the country—from Wick to the Borders and from the Highlands and Islands to Glasgow—there is a lack of confidence in the democracy and accountability of health boards. That is a constant theme in the petitions that are submitted to the Public Petitions Committee. Nearly every reorganisation results in the public being up in arms and reaching conclusions that are the opposite of those reached by the health board. That is unacceptable; the situation is untenable.

Let us consider what is happening now. The issue is not just the public's inability to hold health boards democratically to account; it is the composition of boards. By my reckoning, 41 appointees to NHS boards are ex-Labour candidates or councillors, nine are Liberal Democrats, nine are independent, four are members of the Scottish National Party and four are Tories. That represents a clear imbalance if we consider the proportion of the population that is made up by activists or candidates for the Labour Party and other parties. Two thirds of the appointees who have disclosed political affiliations are members of the parties of the Scottish Executive and only seven appointees—less than 10 per cent—have affiliations with non-Executive parties. There might be even more appointees with Labour affiliations, because only people who have stood as candidates in the past five years are required to disclose their party background. For example, Bill Speirs, the general secretary of the Scottish Trades Union Congress, is an appointee who does not have to declare his Labour Party affiliations, so he is not included in the figures that I have given.

If we are to address the public's suspicions, there must be greater openness and transparency, direct accountability and direct democracy. A secret report—although it is not secret, because we all know about it—expresses great suspicion about accountability, the number of quangos, the performance of the Scottish Parliament and so on. We could restore public confidence and deal with the quango issue by introducing direct elections to health boards. Quangos could be turned into democratically and publicly accountable bodies if we replaced the appointed members of NHS boards with directly elected members who would be answerable to local communities, rather than to the political party in which they are active.

Bill Butler (Labour, Glasgow Anniesland)

Shona Robison mentioned me in dispatches, so I will place a few matters on the record.

It is my intention to issue before the summer recess a consultation paper on my proposal for a member's bill on direct elections to health boards. I give my word on that to Parliament. I sincerely believe that that is the appropriate approach to what would be a far-reaching reform with profound ramifications. To tack on to the bill an amendment, without consultation, would not be an appropriate way of introducing a much-needed reform, as I think that the Health Committee decided at stage 2.

If the results of the consultation are positive, as I think they will be, I hope that the ministerial team will give my proposal a fair wind. I will be interested to hear what ministers say about that later in the debate.

Tom McCabe (Labour, Hamilton South)

I was surprised that Shona Robison lodged amendment 12, after a similar amendment was withdrawn at stage 2. I understood that at that stage she thought that further consultation was needed and that Bill Butler's proposal offered an appropriate approach. I do not think that much has materially changed since stage 2, but we must consider the amendment nevertheless.

Bill Butler has indicated that he has every intention of introducing his member's bill and that there will be an opportunity for proper consultation on the proposals that his bill contains. I am not persuaded that we should legislate in advance of such a consultation and I hope that members want to wait for the outcome of the consultation before they consider whether and how to take forward legislation on such an important issue.

We should remember that the Executive has already taken steps to increase the public accountability of health boards throughout Scotland. The creation of 15 unified NHS boards in September 2001 extended the range of key stakeholders by including local authority councillors. The formal presence of elected councillors as full members of boards was specifically intended to strengthen local accountability, responsiveness to community issues and joint working between health boards and local authorities.

The Executive is also working to improve patient and public involvement throughout the NHS. That is demonstrated by other provisions in the bill. Community health partnerships, for example, will include at least one member of the public partnership forum, who will represent the public's interests. The new duty of public involvement will ensure that boards consult the public on plans and decisions that significantly affect the operation of services. We want to create mechanisms that allow interested members of the public to influence what happens in their health board area and I believe that we are doing that.

This is not the time to introduce the provisions in amendment 12 and I urge members to reject it.

Shona Robison (Scottish National Party, Dundee East)

I will be brief. I thought that it was important to keep the issue of direct elections to health boards on the agenda, so I lodged amendment 12 as a probing amendment, to find out what was happening about Bill Butler's proposed member's bill. I am grateful to Bill Butler for his commitment to proceed with the consultation before the summer recess and I look forward to that process. I am sure that there will be a large response from people throughout Scotland and we will certainly encourage people to respond. Given Bill Butler's commitment, I will seek to withdraw amendment 12.

Amendment 12, by agreement, withdrawn.

Murray Tosh (Conservative, West of Scotland)

Amendment 13, in the name of David Davidson, is grouped with amendments 14 to 20.

David Davidson (Conservative, North East Scotland)

The Health Committee took a lot of evidence about the proposed new Scottish health council and discussed the matter fully. I find it strange that although the Executive has spun the fact that the council is to be established and will be an important body, the bill does not refer to it. That is staggering given that the minister has regularly stated in public that the health council represents a vital part of the modernisation of one aspect of health care in Scotland.

Amendment 13 would include the Scottish health council in the bill and would reinforce the fact that the council should be an independent body and not merely a department of NHS Quality Improvement Scotland or a body that is subject to joint management. The Scottish health council should stand alone.

Local health councils are keen to be linked into a proper national body—neither they nor I object to that proposal—but they want that body to be truly independent. In the past, they worked closely with but were funded by the health boards. However, the Scottish health council should be a truly independent body that considers NHS performance from the point of view of patients and staff and visits the different health establishments in which local health councils have been active and welcome in the past. Currently, one or two local councils do not have the resources or the manning to enable them to be efficient. Amendment 13 would clarify the position. I think that the minister is sympathetic to that aspect of the matter and I ask him to accept that the Scottish health council should be covered in the bill. It is vital that we give the public confidence that independent bodies are there for them and that they can turn to such bodies to investigate any failure in the system. NHS QIS measures quality standards in health service performance on a technical basis; it does not consider that aspect.

Dennis Canavan (Independent, Falkirk West)

I have some sympathy for the member's position, but amendment 13 states:

"The general duties of the Scottish Health Council shall be to ... co-ordinate the work of the local health councils on a national basis".

However, local health councils will be dissolved under section 6. I do not see the point of co-ordinating the work of bodies that will be dissolved.

David Davidson (Conservative, North East Scotland)

The minister seeks to set up local advisory councils. The local health councils want those to come together in a national body that would support and help them. If the bill is passed, local advisory councils will replace local health councils, as the discussions in the Health Committee acknowledged.

I am sympathetic to Shona Robison's amendment 14 and I will listen carefully to what she says. If amendment 13 is not agreed to, we might support amendment 14.

I move amendment 13.

Murray Tosh (Conservative, West of Scotland)

I call Christine Grahame, to be followed by Carolyn Leckie.

Christine Grahame (Scottish National Party, South of Scotland)

I support amendment 13—

Murray Tosh (Conservative, West of Scotland)

I beg your pardon. I made an error; I should have first called Shona Robison to speak to the amendments in her name.

Shona Robison (Scottish National Party, Dundee East)

I seek the retention of local health councils, but that does not mean that I do not recognise the importance of the new national body, the Scottish health council. The two are not mutually exclusive—they have distinct roles. I will say a bit about the independence of the Scottish health council in a minute.

Throughout the passage of the bill, I have expressed concern about the dissolution of local health councils and the loss of their important role, particularly their advocacy work. The councils help some of our most vulnerable people to complain or to find their way round the health service. People have given years of service to their local health council, but the local expertise that has been built up is, unfortunately, in danger of being lost. I have spoken to a number of people who have been involved in local health councils, and they are disappointed and feel that they have been cast aside because their services are no longer required. Although the intention is to try to involve some of those people in the new local advisory councils, those councils will not have the same role, and so a number of people will choose not to be involved.

As I have said throughout the process, I cannot understand why the establishment of the Scottish health council should lead directly to the dissolution of local health councils. It is unfortunate that the Executive has linked those two measures. The Scottish health council and local health councils would have distinct roles. I urge members not to throw the baby out with the bath water and to retain the role of local health councils.

I share David Davidson's concerns about the independence of the new Scottish health council. It would be unfortunate if the message that the public received was that the council was not fully independent or able fully to protect their interests. It is difficult to argue that the council will be independent when it is to be located within NHS Quality Improvement Scotland, which is an NHS body. There are arguments for establishing a different structure to guarantee the new council's independence. I am happy to support David Davidson's amendment 13 to achieve that end.

Murray Tosh (Conservative, West of Scotland)

Since I started Christine Grahame, I will allow her to finish.

Christine Grahame (Scottish National Party, South of Scotland)

My colleague has addressed David Davidson's amendment 13. It is important that the new Scottish health council is put on a statutory basis for the reasons that David Davidson expressed. In evidence to the Health Committee, a recurring theme was the strongly expressed concerns about the independence of such an organisation. The Executive appears to be going for a symbiotic relationship with NHS QIS, but the evidence to the committee shows that there is a strongly perceived conflict of interest, if not an actual one, in relation to the proposal.

Dennis Canavan is right. Mr Davidson's amendment 13 states:

"The general duties of the Scottish Health Council shall be to ... co-ordinate the work of the local health councils on a national basis."

Mr Davidson is trapped by his amendment: he has no option but to support Ms Robison's amendment 14.

Carolyn Leckie (SSP, Central Scotland)

I concur with that point and I hope that Mr Davidson will support amendment 14.

I want to place the debate in context. I hoped that the Executive would listen to the views of organisations such as the Transport and General Workers Union, Unison and the Royal College of Nursing on the proposed abolition of local health councils, which is a serious assault on the independence of the system. A non-statutory body that is located within NHS QIS will be nowhere near a replacement for the rigorous work of local health councils, whose work could be improved further, because there is always room for improvement.

I support David Davidson's amendment 13, which would create a national body to oversee the work of the local health councils—I presume that he supports amendment 14. Amendment 13 would not introduce enough democracy, but it is better than nothing. To give a wee bit of political history, in England, proposals that were similar to the Executive's were at first removed because of opposition by the Tories, Labour back benchers and the Liberal Democrats, but Tony Blair, in his no-reverse-gear mode, insisted on reintroducing them. I hoped that that attitude would not be reflected in the Executive's bill, but unfortunately it is. However, it is never too late—we should stick up for health councils today.

I seek clarification on the policy and intentions of the Lib Dems. When Nora Radcliffe was the health spokesperson for the Lib Dems, she had a members' business debate on 4 October 2000 to celebrate the success of local health councils. I understand that it is published Liberal Democrat policy to support health councils and to oppose their abolition. Perhaps the Lib Dems will let us know what they are doing. We have an opportunity to reach a consensus through which we could retain health councils and introduce an independent national health council.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I am delighted to respond to Carolyn Leckie. I cannot help thinking that if the Executive had proposed another quango, Carolyn Leckie, Shona Robison and David Davidson would have argued how terrible that was. As the Health Committee realised, a number of different options could have been chosen.

What has been missing from the debate so far is a focus on the bill, rather than the amendments. The problem is solved in section 5, which for the first time will introduce in legislation a duty to encourage public involvement. Section 5 states:

"It is the duty of every body to which this section applies"

to consult the public, not only on "planning and development" but, importantly, on "decisions to be made". As the Health Committee knows, people throughout Scotland are dissatisfied with the public involvement and consultation processes of the 15 health boards in Scotland. I am pleased that the Executive is taking action through the bill to ensure that we have real consultations, not consultations after decisions have been made. The bill turns round the situation by talking about "decisions to be made".

Shona Robison (Scottish National Party, Dundee East)

We all agree about the importance of public involvement, but we are talking about the abolition of local health councils and the independence of the new Scottish health council. As Carolyn Leckie said, the previous incumbent of Mike Rumbles's post as health spokesperson had strong views on the retention of local health councils. What is his view on their abolition?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Thank you very much for that. I am trying to put across the point that the National Health Service Reform (Scotland) Bill will radically change public involvement in the health service in Scotland. I hope that SNP members will support the bill at decision time. They would be mad not to accept that the Labour Party and the Liberal Democrats are radically changing the situation, which has moved on in the past four years.

The key issue is the duty to involve the public. As the Liberal Democrat spokesperson on health and community care, I am satisfied that we have the right approach and that the bill will introduce significant changes in public involvement. Therefore I am relatively relaxed about not creating another so-called independent, non-accountable body, which is what David Davidson would like. It is not at all necessary. The whole raison d'être has changed, so placing the Scottish health council within NHS QIS is perfectly acceptable.

Jean Turner (Independent, Strathkelvin and Bearsden)

The beauty of debate is that one is able to change one's mind. Bills go through fairly quickly; as a new member of Parliament, I have found that the process can be difficult, because there is so much to take on board and one changes one's mind many times. I have always felt that it would be a great pity to dissolve the local health councils. Many changes happen in the health service and the most disadvantaged are always penalised. It would have been a great idea to leave the Scottish health council in the bill. In committee, I was persuaded in the end by the minister's assurance that the intention was that the Scottish health council would be independent, under the NHS QIS banner. On reflection, and on reading what has been said in the past, I think that such an important body should have been included in the bill. I go along with everything that has been said.

Mr Davidson said something that made me stop and think. If the Scottish health council comes under NHS QIS but is not included in the bill, it will be subject to regulations. If everybody's intentions are honourable at present, everything will go well. However, if people change, regulations could change, and the whole idea, as it is set up at the moment, might change. Since I am independent, I will vote for amendments 13 and 14. I would have loved it if the Scottish health council had been included in the bill. Throughout the evidence, people's fear that the Scottish health council would not be independent was a constant theme. In the light of the public's mistrust of health boards and the Government, it was a mistake not to put the Scottish health council in the bill.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I will explain why amendment 13 and amendments 14 to 20 should be rejected, just as they were rejected by the Health Committee. Amendment 13 seeks to establish the Scottish health council as a separate, independent body—or, should I say, a supposedly independent body; as Dennis Canavan rightly pointed out, the amendment would ensure that a Scottish health council would be composed of local health council representatives. The key point is that local health councils are appointed by local health boards. David Davidson, Shona Robison and Carolyn Leckie should all remember that point when they applaud the independence of local health councils.

The Executive has proposed that the Scottish health council should be established as a body with its own distinct role and status within NHS Quality Improvement Scotland. That is because the Executive regards patient focus and public involvement as an essential part of securing quality in the NHS. As I say repeatedly, the experience of every patient is the starting point for improving quality in health. In the Executive's view, improving quality should be about developing services that are more focused on patient experience and meeting what patients want through service redesign, managed clinical networks and other initiatives. The review and monitoring functions of NHS QIS will be strengthened by that body being able to draw directly on the expertise and patient networks of the Scottish health council. NHS QIS is at the heart of improving quality in the NHS. It operates separately from ministers and other boards. I am sure that anyone who knows the chair, Naren Patel, will understand what I mean when I say that.

I have written to the Health Committee setting out the Executive's proposals for ensuring the independence of the Scottish health council within NHS QIS, and I reiterate those proposals now. The council will be created through regulations as a committee of the board of NHS QIS. The chair will be appointed through the public appointments process. Members will be appointed through an open process by NHS QIS, and up to three members will be appointed from the local advisory councils to ensure strong local links.

Establishment of the Scottish health council through regulations will mean that there is parliamentary involvement in the process. The Scottish health council cannot be created by primary legislation, because NHS QIS was not created by primary legislation. Establishment through regulations will also mean that there will be a clear, legislative basis for the Scottish health council's work. It will ensure that the council's continuing existence is not just a matter for ministers and the Health Department, and that the council cannot be changed or abolished without parliamentary approval. The council's local advisory structure will mean that it is not a remote or centralising body. By creating a Scottish health council, we will be able to bring more professionalism and expertise to patient focus and public involvement in Scotland. At the same time, the existence of the local advisory councils will mean that there is local input from patients and the public, thus ensuring that the health boards communicate with and listen to patients and local people.

On community health partnerships, there will be the new public partnership forums, which will be important in ensuring that there is strong communication and engagement with the public and, crucially, feedback on key issues and policies.

Christine Grahame (Scottish National Party, South of Scotland)

The minister said that the Scottish health council could not be included in primary legislation because NHS QIS is not included in primary legislation. I do not understand the rationale for that, because amendment 13 makes no reference to NHS QIS. With respect, the argument is not logical.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

Christine Grahame may not agree with the argument, but the Scottish health council will be set up as a part of NHS QIS and it is not possible to have a part of a body in primary legislation when the body itself is not in primary legislation.

Shona Robison's amendments 14 to 20, which are almost identical to those that the Health Committee rejected at stage 2, seek to preserve the status quo. A lot of good work has come out of local health councils—I pay tribute to all the people who have been involved in that—but everybody accepts that that work has been uneven. It is time to build on that good work and to move on. Preserving the status quo would be inadequate for the better public involvement that we want. Mike Rumbles got straight to the heart of the debate when he said that the new structure is all about ensuring better public involvement and better patient focus.

The bill's provisions for a new duty of public involvement and for dissolving local health councils are designed to support and underpin patient focus and public involvement. The Executive wishes to put greater responsibility on NHS boards to communicate with and involve patients and the public, and to encourage patients and community and voluntary organisations to represent their views directly to boards, rather than to have local health councils substituting, as it were, for the public and for those groups. I want to involve the public directly in the planning and design of health services, and not to have their views filtered through an outside body. The Scottish health council will monitor and quality assure that process, and that will do more to help to achieve a more responsive and patient-focused NHS than would be the case if we kept the current system.

I know of the dissatisfaction among members about the way in which public involvement has been facilitated in the past. The Scottish health council's new role will be crucial to guaranteeing better public involvement. For example, all the service change proposals that come to me for approval at present, partly on the grounds that there has been good public involvement, will all be considered by the Scottish health council. The council will report on that, and it will give annual reports on the extent to which boards are improving their work on public involvement. That is crucial to an objective that all members share.

From listening to Shona Robison today, and at stage 2, I know that she wants to maintain local health councils' discrete role in relation to advocacy. The Executive sees local advisory councils as having an important role in ensuring that health boards hear, understand and act upon the views, concerns and experiences of patients, carers, patients organisations and communities. That is a wider role than advocacy in the traditional sense, which is about supporting individuals and helping them to speak for themselves in their relationship with health services. When a local advisory council feels that the patient's viewpoint is not being adequately considered, or when there is not an appropriate patient support group, the local advisory councils will be able to put forward the views of patients and ensure that appropriate action is taken. I made that point at stage 2, and I have written directly to Greater Glasgow Health Council on the matter.

We want to encourage health boards to engage much more directly with patients and with local opinion; at the same time, we will ensure that strong feedback arrangements are in place where the patient's voice, for whatever reason, is not being properly expressed or heard.

We are not disregarding existing interests and expertise. Those people who are currently on local health councils will have an opportunity to be represented on the local advisory councils. They will be the local presence of the Scottish health council; in many cases, those who are currently on local health councils will be the ideal people to fulfil that role and I hope that many of them will choose to do so. They have played a valuable role so far, and they can do more in their new roles in the future. That would have far more value than staying where we are. Accordingly, I encourage members to follow the example of the Health Committee and reject the amendments in this group.

David Davidson (Conservative, North East Scotland)

In fact, it was the whipped ranks of the partnership parties in the Health Committee who voted down my amendment at stage 2, not the committee at large—although we have to accept the numbers game.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Will the member take an intervention?

David Davidson (Conservative, North East Scotland)

No, not at this time. I will come to Mr Rumbles eventually.

This has been an interesting debate, but I do not think that the minister has grasped the significance of my amendment 13. I do not think that he understands the public's worry about the matter or the perception about having a health council that is not regulated, other than through ministers' directions. That is an example of the minister's desire to control all aspects of health in Scotland from his desk. The public are getting very concerned about that centralising approach.

I appreciate the support that I have had on this matter from the other side of the chamber, particularly the points that were made by Shona Robison and Carolyn Leckie. It is important to have a statutory body that can be clearly identified by all members of Scottish society and which acts not just at the behest of the minister, but in a clear, independent manner.

I thought that I heard Mr Rumbles talking about public involvement, and I think that the minister got round to speaking about that, too. What is wrong with public involvement? This is about how we deliver our public services, for goodness' sake. If the public do not have a right to say something, what rights do they have left? If NHS QIS is not enshrined in primary legislation, that is a fact of life. That is why we need to include the Scottish health council in primary legislation, as a distinctly separate, independent body, which is perceived to be independent and to act in the best interests of the patients. That is what the health service is there to do.

Once again, we have seen a Liberal Democrat squirm out of policy commitments from the past, just because there has been a new agreement. I find that very strange, and I think that the Liberal Democrats should be more honest about that.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Will the member take an intervention?

David Davidson (Conservative, North East Scotland)

In a moment.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

He will not do so, will he?

David Davidson (Conservative, North East Scotland)

I am just trying to warm him up, Presiding Officer.

I refer to some of Jean Turner's comments. As a former practising medic in the community, she understands very well the public perception of the situation. Her route to Parliament demonstrated the public's desire for input.

In the interests of democracy, I will allow Mr Rumbles to intervene.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I would have preferred it if the intervention had come from Nora Radcliffe, because she could have put Mr Davidson right on some facts. My point is that our policy has not veered one iota in four years. Is it not rather odd to suggest that committee members from an Executive party should be willing to vote against a policy that they are advocating?

David Davidson (Conservative, North East Scotland)

That says it all, really.

I beg the minister to reconsider the Executive's position on this matter. The proposal in amendment 13 would be an important step forward. If the minister believes in democratic input, as I think that he does, deep down, he should get away from wanting to do everything by regulation. He should have some courage and include the new body, the Scottish health council, in the bill, so that it can actively work for patient care throughout Scotland and build on the good work that has been done. Everybody who is involved seeks a properly resourced national body that is independent enough to work where it wishes in the NHS.

Murray Tosh (Conservative, West of Scotland)

The question is, that amendment 13 be agreed to. Are we agreed?

Murray Tosh (Conservative, West of Scotland)

There will be a division.

Murray Tosh (Conservative, West of Scotland)

The result of the division is: For 48, Against 61, Abstentions 0.

Amendment 13 disagreed to.

Murray Tosh (Conservative, West of Scotland)

The question is, that amendment 14 be agreed to. Are we agreed?

Murray Tosh (Conservative, West of Scotland)

There will be a division.

Murray Tosh (Conservative, West of Scotland)

The result of the division is: For 43, Against 61, Abstentions 0.

Amendment 14 disagreed to.

Murray Tosh (Conservative, West of Scotland)

Group 7 is on the naming of health boards and special health boards. Amendment 4, in the name of the minister, is in a group on its own.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

Amendment 4 is a minor amendment to schedule 1. It removes the existing requirement under the National Health Service (Scotland) Act 1978 that the formal names of health boards should contain the words "Health Board". Under the 1978 act, ministers have a power to name health boards and special health boards by order but, by stipulating that the words "Health Board" appear in all health boards' formal titles, the act limits ministers' discretion on names.

The order that names the various health boards does so according to their geographical location, followed by the words "Health Board"; for example, we have Grampian Health Board and Lothian Health Board. Since 1999, the NHS brand has been developed across the health service in Scotland. Following representations from health boards, I agree that their official names should reflect their names under the NHS brand and their responsibilities for delivering the full range of NHS services, following the dissolution of the trusts.

Amendment 4 allows for the updating of health boards' names to reflect that branding, as has already been done for the special health boards with national coverage. The obligation to use the formulation, "Health Board", will be removed. Members will know from their own areas that boards might already be using their new names; for example, NHS Highland and NHS Lothian are doing so. We want to make that possible as far as the legal use of such titles is concerned. I hope that members will support the proposal.

I move amendment 4.

Amendment 4 agreed to.

National Health Service Reform (Scotland) Bill

Trish Godman (Labour, West Renfrewshire)

The next item of business is a debate on motion S2M-1095, in the name of Malcolm Chisholm, that the National Health Service Reform (Scotland) Bill be passed, and one amendment to that motion.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The passage through Parliament of the National Health Service Reform (Scotland) Bill has been assisted by a great many people and I would like to thank those who have been involved in its progress. That includes the broad range of groups that have taken the time to give evidence to the committees and have represented the views of the national health service, staff, local authorities and the public. I am grateful to the members of the Health Committee, the Finance Committee and the Subordinate Legislation Committee who have debated and scrutinised the bill. Finally, I thank the clerks of those committees and my officials.

The National Health Service Reform (Scotland) Bill contains an important series of measures that will accelerate the development of NHS Scotland into a modern service that responds to and involves patients, that cares for its staff, is free to innovate and is not hindered by bureaucracy.

Having a patient-centred NHS means giving patients and the wider public a voice and an ability to express their views directly to the NHS rather than through a handful of individuals. That is why the bill will make it a legal requirement for health boards to take action to ensure that the public are directly involved in the planning and development of health services, as well as in significant decisions that affect those services. That is not a meaningless duty, but one that will be backed up by a robust public involvement structure that is able to act independently and ensure that health boards perform their duty of public involvement properly.

The key objectives of the bill are to make the planning and delivery of health care more responsive to the needs of local populations; to develop more services in primary care settings; and to break down the traditional barriers between social care, primary care and specialist health services. That is why we are establishing community health partnerships as a key part of our distinctive Scottish health reform agenda. Those partnerships will enable local health care professionals, local authorities, the voluntary sector and communities to work together to improve the health of their local area. They will deliver services to the community in the community where it is safe and sustainable to do so.

The NHS needs to respond to the needs of a diverse Scottish society. That is why the bill also places a duty on the NHS to encourage equal opportunities and I am pleased that the Parliament has agreed to extend that duty to all functions, not just those that are contained in the principal National Health Service (Scotland) Act 1978.

Staff are the core of the NHS and must be properly managed. The bill imposes a duty in relation to the governance of staff that will require boards to have in place arrangements for improving the management of staff and for work force planning.

The bill will provide boards with the freedom to innovate through the duty to co-operate. While we will try to deliver as many services as close to the patient as possible, there are some services that can be delivered safely and sustainably only from highly skilled and specially resourced centres. I want boards to look beyond their boundaries more and to work together to ensure that there is greater and more effective regional planning.

The NHS needs to be able to operate free from unnecessary bureaucracy and barriers. That is why I have dissolved the trusts and will remove the power to create trusts. Primary and secondary care need to be more joined up and that is best achieved through single-system working. Single-system working will allow front-line staff to work together more effectively and, through the schemes of delegation, will empower staff to take decisions on the provision of health care.

When things go wrong, it is important to have effective means of intervening to correct service failure. The health service is a massive and diverse organisation. It would be impossible to prescribe every scenario in which an intervention might take place. However, it is important that intervention takes place only as a last resort and the measure that is contained in the bill will achieve that.

For too long, the NHS has been seen as a reactive health organisation that responds when people are suffering or injured. The NHS, with its partners, needs to be more proactive in promoting health and the new duty of health improvement will achieve that. It will also give boards the powers that they need to do that.

Tom McCabe will cover the details of Shona Robison's amendment to the motion in his speech and, while I look forward to hearing what Shona will say, I fear that I have heard it all before. The NHS is receiving unprecedented levels of funding and the costs of the bill can and will be absorbed by that. It is certainly not right that more of the finite resources that are available should be spent on administrative costs rather than front-line services. The costs associated with the bill are not significant. The bill is about reforming and redesigning existing methods and practice to make them more appropriate for the national health service of the new century.

I am pleased that the Parliament supported the general principles of the bill at stage 1. The bill was improved at stage 2 to include some important new features and I hope that the Scottish Parliament will now approve the bill, which will allow the NHS to develop and continue to be a source of national pride.

I move,

That the Parliament agrees that the National Health Service Reform (Scotland) Bill be passed.

Shona Robison (Scottish National Party, Dundee East)

I thank all those who gave evidence during the passage of the bill. I also thank the Health Committee clerks, who did a great deal of work in getting us to the stage 3 debate.

I welcome the main thrust of the bill. As I have said throughout the process, the Scottish National Party has been keen for a long time to abolish trusts, because we want to remove the artificial barriers that exist between primary and secondary care and which have hindered the delivery of an integrated system of health care across Scotland, and because we want to simplify the system and get rid of the bureaucracy in the NHS that has been a major barrier to change and progress.

However, structural changes alone will not be enough. As I said when I spoke about my amendment 12, on direct elections, we have not seen enough of the real reform that is needed if the public are to be empowered. However, that will have to wait for another day. We need to address the fundamental issues in the NHS, such as capacity and financing, which I will deal with later.

As the minister said, the bill has many positive aspects, such as regional working and community health partnerships, which must be dynamic organisations responding to local needs. I do not believe that they represent in any way a cheap option, as was suggested by some during the evidence-taking sessions. I agree with the NHS Confederation in Scotland, which said:

"The creation of new bodies almost inevitably has additional costs attached ... and Ministers should be aware of this."

Public involvement is another important element of the bill and we all support the idea. However, as I have said, we need to have real public involvement through direct elections. As the NHS Confederation in Scotland said, "continuous public involvement is not cheap, as NHS organisations have found through experience".

We have had a debate around the independence of the Scottish health council and the abolition of local health councils. My concern about those two aspects remains and, although I will support the motion, I want that concern to be on the record.

On finance, I was interested to hear the minister say that he has heard it all before. I think that he is going to hear even more about the issue. I am sure that the minister is aware that, according to senior civil servants, three health boards are in dire financial straits at the moment and seven others could go either way. The minister will hear a lot more about the financial problems that are facing health boards. Legislators have a responsibility not to make the situation even worse by passing legislation without ensuring that the resources will follow.

Health boards will have to find the money from somewhere to fund the public involvement elements of the bill such as community health partnerships; the powers of intervention; the duty of co-operation; and the duty to promote health. I do not believe that there will be no overall additional expenditure as a result of those provisions, and I do not think that many health boards will believe it. The money will have to come from somewhere, but from where? Given that all the new responsibilities will have to be funded, the money will inevitably have to come from services and patient care. Surely we all want to avoid that situation.

The purpose of my amendment is to say that we remain concerned that the financial provisions in the bill are inadequate; I hope that members who share those concerns will support the amendment.

I move amendment S2M-1095.1, to insert at end:

"but, in so doing, remains concerned about the lack of detail in the Financial Memorandum regarding potential additional costs arising from the Bill."

David Davidson (Conservative, North East Scotland)

I join Shona Robison in thanking the clerks and those who gave evidence to the Health Committee; we were well supported during the scrutiny of the bill.

I am, once again, afraid that we have come back to a situation in which the minister runs everything from his desk and all is controlled from the centre. Today, he has—[Interruption.] I heard that. For the record, Tom McCabe said, "If only." That is the ideology of the ministerial team and probably of the Executive and those in the chamber who support it.

I regret the passing of the trusts, because they were a change in bringing forward health care in Scotland. Obviously, they were due for review but, as I have said before, I would have got rid of the health boards, if anything. In fact, many health board chiefs are beginning to think that there will be rapid moves either to amalgamate boards or to examine the roll-out of the managed clinical networks, which are strategic bodies that examine health care in the wider regional aspect, so I suspect that the changes that are made by ministers will not end here.

I do not, from what the minister has said, understand why the opportunity that exists in other parts of the country to use foundation trusts—such trusts are mutual bodies, so they do not represent privatisation—is to be denied in Scotland, where hospitals want to work in that way. I always thought that the minister was keen on public-private partnerships, but that gets spun into the idea that the only good job is a job that is done in the public sector. That is a load of nonsense—the health service was founded on a public-private partnership and many of the professionals who operate in our health service come from the private or voluntary sectors.

Shona Robison mentioned funding, and the minister said that an increasing amount of money is pouring into the health service, but we are not getting an increasing amount of outcomes from all that money. Since the Scottish Executive came to power, the growth in the number of administrative staff has far exceeded the increase in staff who deliver care in the health service. People might be fed up with my talking about the patient journey, but the patient should be the centre of the health service. The patient is what the service is all about, and we should facilitate patients receiving good care at the right time. That should be based not on a general practitioner saying, "This is my friend from the golf club and I want this to be done for him", as the minister thinks, but on a clinical basis—we should trust our professionals.

In a situation in which there are so many points of failure, we must allow the patient to move and we must ensure that health boards that are in trouble do not have to fund care for other health boards without additional funding being offered. That is the basis of the comments that I made earlier today.

There are aspects of the bill that will lead to improvement. There are many good things about the community health partnerships and I welcome the fact that the voluntary sector—which provides an enormous amount of unpaid support in health care in Scotland—will be represented on them.

However, it is also important to ask when we are going to deal with local authorities and health boards working together on patient care, where they have shared responsibility. I still do not understand why the minister refuses to move to a situation in which the budgets are simply brought together and the local authority staff who work on delivering medical care move to the health board. We would then have single patient assessment, a single budget and single management of every case. The twin-track approach is not working in some areas, and I know that one or two councils are looking to take the joint future agenda down the route that I mentioned. There was an opportunity to do that in the bill, but the minister failed to take it.

Once again, we reach the end of passage of a bill that is riven with Scottish Socialist tendencies, although there have been flashes of understanding from the socialists in some respects. I say to the minister that I do not think he will survive the journey for long because, to be quite frank, the people of Scotland expect delivery of health care and not just another big bill.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The bill will fundamentally reform the organisation and management of the NHS in Scotland. It will abolish the last traces of the Tories' discredited internal market by dissolving the NHS trusts. The reforms will also devolve decision making and resources to front-line staff through the establishment of community health partnerships. The bill will also give ministers greater powers to intervene when the health service is deemed to be failing. The principle that prevention is better than cure is an obvious one, and the bill places a duty on health boards and ministers to promote health improvement, which is a long-standing Liberal Democrat commitment. Community health partnerships will delegate existing resources to the front line.

One of the biggest improvements that the bill will introduce is the duty to encourage public involvement; I am pleased that I managed to say something about that while the bill was being amended. The bill will make a remarkable difference in addressing the problems that people throughout Scotland face with so-called public consultation. People will have to be consulted not only on planning and development, but on decisions "to be made"—those three words are extremely important—

"by the body significantly affecting the operation, of those services".

That is a radical improvement, and I am pleased that it will be enshrined in law, assuming that we pass the bill at decision time.

The Lib Dems will not support the SNP amendment, which says that we should be

"concerned about the lack of detail in the Financial Memorandum regarding potential additional costs arising from the Bill."

As Shona Robison will recall, evidence was given on the issue by one of the smallest health boards in Scotland and it told us about what it had saved by streamlining its organisation. Throughout Scotland, that saving should run into millions, so I will not support Shona Robison's amendment.

I turn to the Conservatives' contribution to the debate. People are often turned off politics, and they say—mistakenly, of course—"You lot are all the same." I take this opportunity to thank the Conservatives publicly for tackling that issue as far as health is concerned, because they are indeed being different. They are championing the cause of the private patient at the expense of our national health service. In Parliament, there are real differences between what the Executive parties offer and the ideological approach that is taken by the Conservatives. We are in favour of reforming and improving the national health service in Scotland but—it seems to me—the Conservatives are interested in undermining it in favour of private practice.

David Davidson (Conservative, North East Scotland)

Mike Rumbles is missing this point: if there is health service failure, does not the patient have the right to go elsewhere? We should make the health service as efficient and as well-managed as possible. We are not in favour of privatising the health service. We need to give to choice to the patient, and if care can be delivered by other sources, why should it be denied them?

Trish Godman (Labour, West Renfrewshire)

Mr Rumbles, you must wind up now.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I want to respond to David Davidson. He is quite right to say that patients have rights when the service fails, and that is why the power of ministerial intervention is included in the bill. However, the problem will not be solved by his proposal to undermine the national health service by taking public money away from the public health service and giving it to a private health service. We must have a thriving public health service—in which that money makes a difference—and a separate private health service. We cannot subsidise one at the expense of the other. I obviously have to end at that point.

Janis Hughes (Labour, Glasgow Rutherglen)

I thank the clerks and other Parliament staff who have helped in the process of bringing the bill to Parliament and I thank those who gave evidence as part of that process.

The National Health Service Reform (Scotland) Bill contains much that is to be welcomed, so I am pleased to be able to support it. One of the main principles that underpins the bill is the removal of unnecessary barriers and bureaucracy from the national health service. The bill will devolve more power so that services can be delivered in communities. The NHS should not be a one-size-fits-all service.

The bill will help to facilitate much more local decision making. In part, that will be achieved by the creation of community health partnerships. CHPs—which will replace the current local health-care co-operatives—will require the establishment of joint working with local authorities and other partnership agencies as part of the community planning process. They will have budgetary control and dedicated staff to allow the development of services that best meet local needs in communities and that can be integrated with social care and other local services.

Another important aspect of the bill concerns public involvement in decisions that affect service development and delivery. We have already heard much about public involvement today. In recent years there have throughout Scotland been major changes in the way health care is delivered. For many reasons—too many to go into today—change is necessary, but it is often not without pain, and consultation methods have varied greatly among health boards. Although the Executive has produced guidelines in the form of policy documents, those have not always led to meaningful consultation. The bill will enshrine the need to secure the public's involvement in the planning and development of their health services.

In addition, the bill will place a duty on health boards to co-operate with other health boards and other agencies in planning and providing services. In recent months, there has been much criticism of the lack of regional planning of services. Health boards have taken in isolation decisions that have had effects on neighbouring boards. Although I welcome the measures in the bill, I would like further guidance from the Executive on the consultation process. I hope that the minister can give some assurances on that when he sums up.

One aspect of the bill that I welcome particularly is the promotion of health improvement. As I have said before in the chamber, health improvement has for too long been the Cinderella of the health service. Often, it is the first area to be targeted when money is short. The bill will impose a duty on ministers and health boards to promote improvement of the physical and mental health of the Scottish public. I very much welcome that and I hope that we will in the near future see more details on how that will be done, especially on how boards will work with key partners, such as those in the voluntary sector.

During the Health Committee's evidence-taking meetings on the bill, the British Medical Association, the Royal College of Nursing, Ayrshire and Arran Primary Care NHS Trust and others highlighted the fact that staff governance had been omitted from the bill. The Health Committee raised that issue with the minister at stage 1. I am pleased that the minister took our comments on board and that the duty for staff governance will, after today, be enshrined in legislation.

In conclusion, the bill contains much that is to be welcomed. It brings together a number of recent health care policy developments, such as the joint future agenda, "Designed to Care" and "Partnership for Care". It also addresses a number of concerns that we have had about issues such as consultation and regional planning. I believe that the bill will do much to improve our health service and I will be pleased to support it today.

Christine Grahame (Scottish National Party, South of Scotland)

In the interests of brevity, I will speak only in support of the SNP amendment.

As my colleague, Shona Robison, pointed out, the budgets of three health boards are currently in extremis and the budgets of another seven are on the cusp of being so. From the evidence that the Health Committee received on the budget, we are aware that the increase in expenditure for Greater Glasgow NHS Board will cover only inflation, the increased staffing costs arising from the new contracts and the costs of complying with European directives. Therefore, any clinical initiatives that the minister wishes to prioritise will require cuts in other clinical services. Another example of such a situation is provided by Argyll and Clyde NHS Board. The Auditor General's report states:

"The auditor considers that NHS Argyll and Clyde's cumulative deficit could reach £60-70 million by 2007/08 and may be irrecoverable."

That is the background against which the Scottish National Party challenges the assertions in the financial memorandum to the bill. Our position is corroborated and supported by the Finance Committee's report. The financial memorandum pretty much states that the major changes—which we support—to the structure of the NHS will be cost-neutral. Paragraph 41 of the financial memorandum states:

"The Executive is of the view that there will be no impact on other aspects of public expenditure, including local authorities, or on the costs of the voluntary or private sectors or individuals, as a result of the provisions in the Bill."

Perhaps the minister should address that point when he sums up.

My comments on the financial memorandum are based mainly on the Finance Committee's report, which makes very interesting reading. The report from that secondary committee provided our committee with important and helpful support for our findings. Indeed, I associate myself with the remarks that the deputy convener and my other colleagues on the Health Committee have made about the evidence that was given by witnesses and about the hard work of the clerks.

Paragraph 13 of the Finance Committee's report makes an important point:

"The Committee questioned whether the Scottish Executive could have provided a clearer financial assessment of the costs and savings associated with abolishing NHS Trusts, especially in the initial phases, rather than assuming that they would offset each other."

At paragraph 17, the report states:

"The Committee also received evidence highlighting concerns that until details on the structure, number and scope of CHPs are determined, it is difficult to state whether or not the Financial Memorandum of the Bill is correct."

When members introduce members' bills in the Parliament, they need to ensure that their financial memoranda are correct: it seems to me that there is one rule for members' bills and another for Executive bills, because it is still not clear that those questions have been answered.

Paragraph 29 of the Finance Committee's report deals with the costs of intervention. The minister said that he would address that issue perhaps by spreading the cost across health boards, but that still does not answer all the questions that the Finance Committee report asks. Paragraph 29 states:

"The Committee remains unconvinced that the estimated average cost"—

not liability—

"associated with the power on intervention is reasonable based on the evidence it received."

The Health Committee also pointed out that no assessment has been made of the cost implications of the recommendations that a health board will have to implement following an intervention. Will those costs be paid by the health board in question or will they be spread throughout Scotland? What are the cost implications?

Finally, paragraph 43 of the Finance Committee report deals with public consultation, on which the minister has given us some undertakings. The report states:

"The Committee would recommend that the Health Committee further pursue whether the funding provided at present is adequate for carrying out public consultation as detailed in the Bill."

The health boards that were mentioned are quite small health boards, but other health boards cover large areas and have major deficits. My party is not convinced that the bill is financially neutral.

Carolyn Leckie (SSP, Central Scotland)

The Executive is either burying its head in the sand or wilfully under-resourcing the NHS. To suggest that the bill has no financial implications and that NHS boards will be able to absorb the changes flies in the face of the evidence. That is why I will support the amendment in the name of Shona Robison.

Let me quote from a letter that was recently issued to a division of one NHS board. The letter ably demonstrates the sort of pressures that boards face and the drastic measures that they are considering in order to bring themselves into financial balance.

Under the heading "Benchmarking acute services and identifying potential to reduce capacity", the letter suggests that the division will have to review its

"homeopathic service ... All 'standalone' rehabilitation hospitals ... Dermatology inpatient beds"

and

"Conversions to five day wards".

It will also have to "Reduce continuing care beds" and

"Close beds to reflect reduced cross boundary flow".

On prescribing, the letter states that the division will have to

"Restrict introduction of new drugs"

and implement an "Aggressive cost reduction programme".

On pay, it says that the division will have to

"Manage introduction of Agenda for Change within funding available".

That means tinkering with the agenda for change, which was supposed to be an independent evaluation of people's roles.

The recommendations go on. The division will have to "Reduce agency costs",

"Identify potential for reduced and reshaped workforce"—

which means job losses—and

"Identify potential to reduce mental health beds".

I could go on. The letter contains 14 separate recommendations for cuts and many of the recommendations are broken down into further subsections. That letter describes reality.

Although we will support the bill, we have serious reservations about the impact that it will have on costs to NHS boards and the ensuing impacts on services to patients. I remain concerned about a number of the details. The jury is still out and continuous scrutiny will be required.

I will not repeat all the points that were made earlier in relation to the amendments on health councils. There is a serious lack of democracy and accountability in the provision of health services, which the bill does not address in any way. The bill deals with delivery of health and social care, which was previously part of the joint future agenda, but it does not address unequal terms and conditions, roles, responsibilities and training. The question of accountability of staff—who their employer is and how their status is monitored—is also not addressed. There are difficult issues on the ground.

There will not be enough trade union and clinical input into the composition of community health partnerships and the BMA has told us that there will not be enough input from GPs, for example. However, there will be an increase in the participation and influence of private business. I have deep concerns about that.

The bill provided us with an opportunity to introduce national collective bargaining for NHS staff in Scotland. That opportunity has been missed, which is unfortunate.

I challenge the Executive to be realistic about, to justify and to indicate what it will do about the current financial situation. It should justify the introduction of legislation that will place a burden on NHS boards, which workers must deliver and boards must manage. Where will the funding come from? The reality is that services are being cut left, right and centre.

Nanette Milne (Conservative, North East Scotland)

The problem with the NHS in Scotland today is not funding, but that it is driven from the centre and has constantly to respond to centrally set priorities and targets, each of which puts more pressure on the system and results in more administrative costs, harassed staff and frustrated patients waiting to access the system.

The National Health Service Reform (Scotland) Bill was a golden opportunity to put things right—to turn the system around and truly to devolve decision making in the health service from politicians to professionals and patients. If there were a focus on the needs of the patient and funding went with the patient, choice would open up for them and the service would soon respond. Sadly, that opportunity has been lost.

The removal of NHS trusts apparently involves the removal of a layer of bureaucracy, but we see it as a move away from the patient towards centralisation because—essentially—the trusts have been subsumed as operating divisions of health boards, which are one step further away from patients.

There is merit in much of the bill, but we still have many concerns about it. The development of managed clinical networks deriving from regional co-operation between health boards is a step in the right direction, but it falls far short of our proposals to allow patients the option of receiving their treatment from any NHS provider or from the voluntary, not-for-profit and independent sectors if they choose, based on a national tariff system that would define set costs for specific procedures, as explained by David Davidson.

I will respond to the criticisms of our policies. As I have said often in the chamber, I am and always have been a passionate believer in the NHS. My family has more reason than many to be grateful to it, following my son's successful liver transplant 12 years ago. However, as Jean Turner did, I point out that many private patients are only private patients because they cannot timeously get the treatment that they need from the public service. I know many elderly people who are by no means wealthy and who have given their life savings to procure the treatment that they need. There is no reason why those people, who have contributed to the NHS all their lives through taxation, should not take a part of the cost of their treatment with them, which would free up space in the service for those who are still waiting to gain access to it.

The development of local health care co-operatives into community health partnerships has merit and will give local stakeholders and front-line staff a role in decision making on the delivery of local health care services, which must be in the interests of the patient. However, there is still much work to be done on the statutory guidance for CHPs—on their remit, role, membership, number and cost. It is extremely important that the Health Committee has the opportunity prior to their introduction to scrutinise the guidance and regulations relating to the operation of CHPs.

The duty on health boards to ensure public involvement is a positive step but, as the BMA stated, if the proposed Scottish health council and CHPs together are to engage the public and encourage them to play a meaningful role in community planning, it is essential that that work receive appropriate funding. We still have doubts about whether the proposed Scottish health council can be truly independent as part of NHS

Quality Improvement Scotland and we do not agree with the proposal.

We also have serious concerns about the cost of the provisions in the bill, particularly in relation to intervention, CHPs and the Scottish health council.

Christine Grahame (Scottish National Party, South of Scotland)

Will the member take an intervention?

Trish Godman (Labour, West Renfrewshire)

The member is winding up.

Nanette Milne (Conservative, North East Scotland)

We question the Executive's claim that the bill will be cost neutral. It is a particular concern that health boards could incur the costs of intervention at the very time when they are facing serious financial difficulties.

We see merit in some of the proposals in the bill but we have serious concerns about others. Above all, we see the bill as a missed opportunity for true reform of the NHS in Scotland—to put the patient and health professionals at the very core of the service. Sadly we cannot, therefore, give the bill our support.

Tom McCabe (Labour, Hamilton South)

This has been an important debate for the future of the NHS in Scotland. I express my thanks to those who have been involved in the passage of the bill.

The bill that we are being asked to pass today will update the principal act that governs the national health service—the National Health Service (Scotland) Act 1978. It will ensure that the right legislative framework is in place to enable the NHS to move forward, to modernise and to adapt to the needs of a 21st century health service.

However, the founding principles—that health services should be free to all at the point of delivery and that health professionals should be able to work together without barriers to deliver the best possible care—remain as valid today as they were in 1948. Those principles are widely shared by the people of Scotland and by many of the people who gave evidence on the bill.

It is disappointing, though not surprising, that the Conservatives have fundamentally misunderstood what the bill is about. The bill is about decentralising as much as possible down to front-line staff. It is remarkable that David Davidson and his colleagues harp on about centralisation when, week after week, they ask for specific funding for particular conditions or for their pet project of the month. Week after week, they ask for central direction from the Executive, but in this debate they have harped on about their claim that the bill is about decentralisation. It is not. The bill is about health boards becoming single bodies and about community health partnerships delivering services locally with local authorities and other partners and pursuing safe, sustainable services. It is about our being able to take action to ensure that local and regional services are provided to an adequate standard. That is the reform agenda that is right for Scotland and which will provide high-quality health services right across the country.

As members know only too well, the Government is injecting record amounts of money into the national health service, but the money pot is not bottomless. Tough choices need to be made, especially in relation to specialised services, and the public need to be meaningfully involved in those decisions. In some cases, the status quo is not an option if we are to continue to provide safe high-quality services. No one group can opt out of making choices—not the Executive, not health boards and not the public. The duty of public involvement is just that—a duty to involve the public in decisions. It is not a duty to avoid making decisions.

As the Health Committee recommended in its stage 1 report, safeguards will be put in place to ensure that the proposed Scottish health council and its local advisory councils are able to act at arm's length from the bodies that they monitor. That will be achieved through the regulations that will establish the health council—regulations that the Health Committee will be able to scrutinise.

The National Health Service Reform (Scotland) Bill will also address the balance in the NHS between health treatment and health improvement. That is important to our vision of what a health service should be, which is of a service that actively promotes health improvement, rather than just a service to which people turn when their health is failing. A focus on health improvement will lead to a healthier population, which is better for the NHS and better for our country.

Finally, I want to address Shona Robison's concerns about the financial memorandum that accompanied the bill. As Malcolm Chisholm said in the short debate on the financial resolution at stage one, it is no surprise that the SNP's only substantive contribution is—yet again—to call for more resources.

The bill that we pass today will lead to some additional costs. That has always been clear, but there will be additional savings which, together with the redistribution and better management of resources, will more than make up for the additional costs.

Shona Robison (Scottish National Party, Dundee East)

Will the minister give way?

George Reid (None, Ochil)

No—he must conclude.

Tom McCabe (Labour, Hamilton South)

Okay.

I will give the example of the dissolution of trusts. We know that Dumfries and Galloway NHS Board saved £500,000 in one year after its move to single-system working and that Borders NHS Board saved a similar amount, albeit over a longer time. However, the move to single-system working is not about cutting costs; it is about improving health care for patients through greater co-operation and collaboration. If savings can be made, I expect them to be reinvested in the front line.

The new duty of health improvement is designed to make it easier for boards and ministers to spend existing money more effectively on promoting health improvement. We already spend large sums of money on promotion of health improvement. Examples include the extra £173 million that was announced in "Building a Better Scotland", on top of the £134 million that is already being spent between 2003 and 2006.

As Malcolm Chisholm said in his opening speech, we have seen record levels of investment in the NHS in Scotland. Those resources can and must be used more effectively and that is what the bill is all about. I urge members to reject the SNP amendment.

Today, we are being asked to pass an important bill that will reform the NHS so that it continues to deliver quality health services to the people of Scotland. To do that we need to reduce bureaucracy, increase collaboration, delegate functions that can be delivered locally to community health partnerships, support staff and intervene effectively when necessary. The bill will achieve that and more. I strongly urge every member to support it.

First Minister's Question Time

John Swinney (Scottish National Party, North Tayside)

To ask the First Minister when he next plans to meet the Prime Minister and what issues he intends to raise. (S2F-859)

Jack McConnell (Labour, Motherwell and Wishaw)

I have no immediate plans to meet the Prime Minister.

John Swinney (Scottish National Party, North Tayside)

This week, once again, a prisoner was released in error from Scotland's courts. Yesterday, a senior official from the Scottish Prison Service told the media that mistakes such as the one this week were fully expected. What allowances were made for mistakes over prisoner release in the contract that was issued to Reliance Secure Task Management?

Jack McConnell (Labour, Motherwell and Wishaw)

The references in the contract with Reliance to prisoners released in error—I hope that I am not divulging information too far in advance of the full publication of the appropriate parts of the contract—refer directly to the penalties that Reliance will pay for releases in error.

John Swinney (Scottish National Party, North Tayside)

That raises the questions what those penalties are and why we have waited for so long for the First Minister to publish the contract so that the public can be reassured on the issue.

On 22 April, the First Minister told Parliament that Reliance had failed to implement its contract and that, as a result, it would face a penalty. However, reports this week suggest that no penalty would be paid until 14 prisoners had escaped or had been released in error. Given that the Reliance contract has not yet been published, can he tell Parliament whether a specific penalty will be paid for the release of James McCormick, or will we have to wait for more prisoners to be released in error before the company faces any penalty?

Jack McConnell (Labour, Motherwell and Wishaw)

As the Minister for Justice and I have said before, Reliance will have to pay penalties for the prisoners who have been released in error. The contract will be published as soon as possible. It will be published, as was explained in the chamber two or three weeks ago, in the interest of public safety. We will ensure that every piece of information in the contract that can be published in the public interest will be published.

John Swinney (Scottish National Party, North Tayside)

What is stopping the First Minister giving an answer to a parliamentary question about the penalties that there will be for the release in error of James McCormick and any other prisoners? It is now four weeks since the first prisoner was released, so there have been four weeks in which to resolve the issue. We have been told that the Minister for Justice is dealing with it as a priority, but it should take not weeks but days to resolve. Why has the contract not been published and why will the First Minister not accept the enormous public unease about the issue, dump the contract and start to rebuild public confidence?

Jack McConnell (Labour, Motherwell and Wishaw)

The way to build public confidence in our justice system is to implement the reforms that we are implementing. Those include not only the reforms to the courts that the Parliament agreed last week, the further reforms that will come in our legislative programme and the reforms that have already been implemented in the Procurator Fiscal Service, which are delivering a more efficient and effective service, but the reforms to prisoner escorts. Not only will the reforms to prisoner escorts release professional officers to look after the job that those officers want to do—to catch criminals and prevent crime—but they will ensure that the measurement of problems in the system is done properly, is transparent and, for the first time, allows us to act against those who are responsible.

John Swinney (Scottish National Party, North Tayside)

Why is it taking so long to publish the contract and what are the specific penalties that Reliance has to pay for the release of the six prisoners who have been wrongly released to date?

Jack McConnell (Labour, Motherwell and Wishaw)

We have already explained why it will take time to publish the contract. It is because parts of the contract should not be published. That is a clear position.

It is also important that we ensure that not only the prisoner escort service but the justice service as a whole is reformed and improved, and the events of this week merely prove the need for that reform. The fact that a prisoner was being taken to two different courts on the same day is a justification for reform, not an argument against it. Recriminations, rants and rhetoric might be good enough for the Scottish nationalist party's internal workings, but with the Labour-Liberal Democrat Administration in Scotland, we get investment and reform and we will get results.

David McLetchie (Conservative, Edinburgh Pentlands)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-860)

Jack McConnell (Labour, Motherwell and Wishaw)

We will agree tomorrow the agenda for next week's Cabinet meeting.

David McLetchie (Conservative, Edinburgh Pentlands)

We await with bated breath the outcome of those deliberations. I suggest that the Cabinet discuss health in Scotland, because I am sure that it and the First Minister are aware that, despite a 30 per cent increase in funding for the national health service in Scotland since 1999, 40,000 fewer treatments are taking place in our hospitals while more than 20,000 more patients languish on hospital waiting lists. Is that not the ultimate indictment of the Executive's mismanagement of our health service?

Jack McConnell (Labour, Motherwell and Wishaw)

It is a good thing that millions more people in Scotland are being treated in out-patient departments rather than being treated as in-patients. That is a great development in our health service and a tribute to the staff, including the management and the so-called administrative staff, whom David Davidson was castigating this week and who have dramatically reduced waiting times in Tayside, the area immediately south of the one that Mr Davidson represents in the Parliament. Those members of staff, who have been working hard with the consultants and the professional medical staff to reduce those waiting times, will have found Mr Davidson's comments very interesting indeed.

Mr McLetchie is wrong if he thinks that it would be better for us not to treat people as out-patients and not to increase dramatically the number of people who are treated as out-patients and who are in and out of hospital inside a day, but to force them to stay overnight in hospital beds so that we can keep the numbers up. In Scotland, we should have a modern health service that treats people efficiently, allows them to be in and out of hospital as quickly as is medically appropriate and ensures that they are treated to the highest possible standard of care. That is the objective and what is being delivered; it is certainly not what would happen if the Tories were back in power.

David McLetchie (Conservative, Edinburgh Pentlands)

Unfortunately, all the First Minister's fine rhetoric is completely at variance with the facts. If we look at the latest statistics measuring in-patient and day-case discharges from our hospitals that the information and statistics division has published, we find that there are 70,000 fewer than there were in 1999. If we look at the number of contacts with general practitioners in Scotland between 1999 and 2003, we find that there are nearly 1 million fewer. Those are facts from the Administration's own statistical body. If we examine the number of treatments in hospitals, we see not only that 40,000 fewer treatments took place in 2003 than in 1999, but that in comparison with 2001—when the First Minister took over—50,000 fewer treatments took place, and that 20,000 more people remain on the waiting list. Far from getting better, are things not getting worse?

Jack McConnell (Labour, Motherwell and Wishaw)

All over the country, families realise that in the health service today, a treatment that previously involved a stay in hospital can now be obtained within a day. A treatment that once required a visit to hospital can be obtained in a short visit to an out-patient clinic. It is good that that has happened. We should not reverse that and somehow force people back into hospitals, rather than giving them the care that they need in their community, where they can now enjoy it.

There is a long list of figures that have gone up in the national health service since 1999—it is five years to the day since the Parliament was first elected. The number of staff in the health service is up, but increases apply not only to the total number of staff. The number of nurses and midwives is up 5.3 per cent; the number of qualified nurses and midwives is up 7.5 per cent; the number of medical staff and doctors is up 10.4 per cent; the number of hospital and community health service professionals is up 19.3 per cent; and the numbers of consultants, dentists and practice nurses are also up. That is good for the health service. Those staff are working in communities and making a difference. Some day, the Conservatives will realise that they were wrong and that we are doing it right.

David McLetchie (Conservative, Edinburgh Pentlands)

The First Minister tells us everything that is up but forgets the most important matter: results, which are down. That is the key feature of the centralised, target-driven service that he and the Scottish Executive are running. The chairman of the British Medical Association in Scotland criticised that service this morning.

Things are getting worse, not better, so why will the Executive not reverse a process that is failing people in Scotland on health care and instead devolve power and responsibility to give patients and hospitals choice and control over how the service develops in response to their needs?

Jack McConnell (Labour, Motherwell and Wishaw)

I reiterate that it is better for people to be treated in their communities than in hospitals. It is better for people to be treated quickly in one day than to be treated overnight. That allows nurses, doctors and allied health professionals to make a better contribution to the health service and to treat people themselves rather than always to refer somebody up the tree. It is better that administrative, clerical and managerial staff take work away from doctors and consultants to free up their time to perform more operations and treatments and to treat people more quickly. That is the way to change and improve our national health service. The Tories cannot even imagine having such a record, but we will have that record.

George Reid (None, Ochil)

We will hear two urgent questions.

Pauline McNeill (Labour, Glasgow Kelvin)

The First Minister will be aware of Greater Glasgow NHS Board's controversial decision to close the Queen Mother's hospital, which is in my constituency. The regional director of the service for transporting ill babies has described that decision as taking an unacceptable risk. Does he acknowledge that the foetal therapy department at the Queen Mother's is recognised internationally as the home of foetal medicine? Does he acknowledge that, until now, Scotland has been at the leading edge of tackling neonatal and child illness? Will he assure me that he will not allow that national service to suffer? Will he listen to experts at the Queen Mother's hospital?

Jack McConnell (Labour, Motherwell and Wishaw)

Ministers are well aware of the strong support that Pauline McNeill and other members have given to the campaign on the issue. She will be aware that the Minister for Health and Community Care, Malcolm Chisholm, is considering a proposal from Greater Glasgow NHS Board. He and I have said consistently that the proposal will be considered carefully. All the arguments will be heard. Ministers can say no as well as yes to proposals from health boards. When the final decision is ready, it will be announced to the chamber.

Kenny MacAskill (Scottish National Party, Lothians)

The First Minister will undoubtedly agree that the collapse of the airline Duo Airways was a blow for travellers and employees in Scotland. Does he agree that in the creation of new direct routes, some turbulence must be expected? If so, will he confirm that the route development fund will continue, albeit with a review of its payment methods and operation? Will he undertake to seek new operators for the highly successful routes that operated from Edinburgh to the likes of Oslo, Geneva and Munich?

Jack McConnell (Labour, Motherwell and Wishaw)

I am delighted to have Kenny MacAskill's support for our route development fund, which is one of the greater successes of the coalition Administration in Edinburgh. The new routes have been a success. It is clear that the outcome this week for the company that Kenny MacAskill mentioned is a major blow for passengers who had booked to use that company, as well as for those who are involved in it. However, not only will the route development fund continue, it will be reviewed in order to find out whether we need to increase it and develop its use.

I will do a deal with Kenny MacAskill. If he is willing to support the fund and we are willing to keep it going, perhaps in future he will avoid saying in Edinburgh that Glasgow gets too much, and saying in Glasgow that Edinburgh gets too much. If he is prepared to back the fund nationally, we will join him.

Tommy Sheridan (SSP, Glasgow)

To ask the First Minister what issues he will prioritise for discussion with the Prime Minister at his next meeting with him. (S2F-875)

Jack McConnell (Labour, Motherwell and Wishaw)

No immediate meeting is planned with the Prime Minister.

Tommy Sheridan (SSP, Glasgow)

Last year, the First Minister said in the chamber:

"The mark of leadership in Scotland is to speak on the big issues of the day, but to do so honestly and consistently."—[Official Report, 13 March 2003; c 19437.]

The First Minister also said that military action in Iraq was justified because the Iraqi regime was unwilling to give up its weapons of mass destruction and that he was on the side of the Iraqi people. More than 12 months later, is he honest enough to admit that he was wrong about Iraq's weapons of mass destruction? If he is still on the side of the Iraqi people, will he call on the Prime Minister to bring our troops home immediately and to put an end to the illegal occupation of Iraq by British and American troops?

George Reid (None, Ochil)

Before the First Minister answers that, I should say that he is, of course, responsible for what he has said to the Parliament and that it is in order to ask him about what he has said to the Parliament. However, it is not in order to ask the First Minister about matters that do not fall within the general responsibility of ministers. So far, I judge Tommy Sheridan's questions to be just within the limits.

Jack McConnell (Labour, Motherwell and Wishaw)

I hope that you judge my answer to be just within the limits, Presiding Officer; for that purpose, I will keep it brief.

It would be wrong-headed and extremely ill judged to take British troops out of Iraq at the moment. I cannot think of anything that would make such an unstable situation far worse. It is important that the people of Iraq are supported by Britain and other countries around the world, whether or not those countries were involved in the conflict at this time last year, which, I remind Mr Sheridan, was successful in removing the world's worst dictator from power. It is important that countries that were or were not involved are engaged in supporting the people of Iraq to move as quickly as possible not only towards looking after their own internal and external security but towards democracy and free elections. If we achieve that, we will have achieved something that is very worth while.

George Reid (None, Ochil)

Mr Sheridan should remember my ruling.

Tommy Sheridan (SSP, Glasgow)

Around five months ago, the First Minister said that the positive outcome of the illegal invasion of Iraq was that

"The people of Iraq now have a chance to express their opinions."—[Official Report, 20 November 2003; c 3470.]

CNN is a biased source, but even the CNN/USA Today/Gallup poll that was published last week found that 64 per cent of Iraqis believed that coalition actions have turned out to be worse than they had hoped. Some 57 per cent said that all coalition troops should be withdrawn immediately and 70 per cent said that they view the troops not as liberators but as an occupation force. Those are the opinions of the Iraqi people. Will the First Minister be honest and consistent enough to call on Mr Blair to follow the example of the Spanish socialists and withdraw troops from their illegal occupation of Iraq?

Jack McConnell (Labour, Motherwell and Wishaw)

I have expressed my view on the matter. To remove British troops from Iraq now would be ill judged and wrong. It would lead to greater instability and would almost certainly lead to more Iraqis dying in the weeks and months ahead. It is important that we work with those people in Iraq who want to ensure that there is proper security and democracy in Iraq, to defeat those who want to bomb their way out of the situation and to ensure that people in Iraq have a future that they can enjoy in an atmosphere of democracy and peace. That should be our objective and we should stick to it.

Kenneth Macintosh (Labour, Eastwood)

To ask the First Minister how the Scottish Executive plans to improve Scotland's tertiary education sector. (S2F-870)

Jack McConnell (Labour, Motherwell and Wishaw)

We want a Scotland that has both world-class universities and top-quality colleges accessible in every community. That is why we are not only investing increased resources but maximising the use of those resources on teaching and research. That will benefit not only individual students but Scotland as a whole.

Kenneth Macintosh (Labour, Eastwood)

Will the First Minister reassure those of us who woke up on Friday morning to rather mystifying reports that we might be about to abolish Scotland's universities that that is far from being the case? Will he confirm that, as he has said, we are committed to building on substantial increased investment in our higher education sector; that additional resources for our universities have already been committed through this year's spending review; that we are committed to widening access and supporting students through the abolition of tuition fees and the reintroduction of bursaries; and that the proposed merger of the funding councils will allow us to take fair and strategic decisions that affect the whole of further and higher education in Scotland to allow us to take continued and justifiable pride in the world-class reputation of our universities?

Jack McConnell (Labour, Motherwell and Wishaw)

It is important to reduce bureaucracy at the centre and to ensure that resources are devoted properly to teaching and research, whether that is in our colleges or in our universities. Our commitment to increased investment in our universities and colleges remains. Our commitment to improving the breadth of access in our universities, rather than just increasing the numbers, is clear. Our commitment to increasing the numbers of people who have the benefit of further education at all ages in this country is clear. Our absolute commitment not to abolish Scotland's universities—in contradiction of some of the nonsense that was around last Thursday night and Friday morning—or, for that matter, our further education colleges, should not only be clear to the chamber but have been obvious to anybody who thought about the matter for longer than five minutes.

Fiona Hyslop (Scottish National Party, Lothians)

Does the First Minister agree that it makes no sense for Scotland to move away from a distinction between further and higher education just as the Bologna process is getting into its stride and when other European countries are looking to the Scottish system as the ideal? Does he acknowledge that his Deputy First Minister has managed—not for the first time—to create a problem where there was none before? Does the First Minister understand that it is the detail of the draft bill to merge higher and further education that might undermine our position in the European higher education area and damage our ability to attract students from elsewhere? Does he understand that it is the extra details in the bill, on top of the simple merger of the funding councils, that are in danger of causing chaos and confusion where there should be collaboration and co-operation between the university and further education sectors?

Jack McConnell (Labour, Motherwell and Wishaw)

I am sure that many people would enjoy the creation of chaos and confusion, but it would be a shame if the debate were to continue in that way. The proposed change is important and it needs to be the subject of proper consultation. Some people in the chamber are not impressed with consultation—we understand that from the Tory perspective—but we are committed to consultation and we will listen to the points that are made.

However, we are determined to ensure that resources are focused on front-line teaching and research; that the highest possible quality exists both in our universities and in our colleges; that the identity of and distinction between our universities and colleges remain crystal clear; and that the seamless transition from school to college to university that exists in Scotland under our qualifications framework is a strong one that is admired throughout the world. That framework is now being taken up by the Chinese Government. It is important that we are able to ensure that we promote and continue to improve our universities, but we must also have a qualifications framework that allows people to climb through the system to reach the very top if they can.

James (Conservative, Lothians)

With regard to tertiary education, is the First Minister aware that, as part of the European year of education through sport 2004, a number of projects at local, regional and national level will be selected and co-financed by the European Commission? Will he assure the Parliament that the Executive will give every support to securing as many as possible of those projects for Scottish educational institutions?

Jack McConnell (Labour, Motherwell and Wishaw)

There should be no doubt about our commitment to maximise the availability of European funds for the benefit of Scotland and to participate enthusiastically in the symbolic European years to which the member refers and which can be important in raising the profile of certain issues. I hope only that between now and the year in question a Conservative Government is not elected in London, as that might lead to our leaving the European Union and not participating in the year at all.

Robert Brown (Liberal Democrat, Glasgow)

To ask the First Minister how the Scottish Executive is addressing the health gap between rich and poor. (S2F-873)

Jack McConnell (Labour, Motherwell and Wishaw)

It is unacceptable that anyone should be consigned to a life of ill health, restricted opportunity and a shortened life span because of the circumstances into which they were born or because of where they live. We have targeted measures at areas of greatest need and developed the most comprehensive health improvement programme ever seen in Scotland. It is working—indeed, it was praised this week by the World Health Organisation—and we are committed to following it for the long term.

Robert Brown (Liberal Democrat, Glasgow)

Is the First Minister aware that a team at the University of Liverpool recently found that Scotland and London had the widest health gaps between social classes? Does he agree that Scotland's health picture is heavily influenced by the situation in Glasgow, where the reported life expectancy is as low as 63? Although I accept that much good work has been done in this area, is the time not ripe to tackle the city's health problems by setting up a ministerial action team that would establish key milestones to achieve significant improvements, in particular the improvement in health to which the First Minister has rightly given so much attention?

Jack McConnell (Labour, Motherwell and Wishaw)

We have already targeted new resources not just at Greater Glasgow NHS Board but at Glasgow City Council, which is funding many of the exercise and diet programmes that are making such a difference in the city. Furthermore, our partnership agreement contains a commitment to establishing a new centre for the study of population health, which will be based in Glasgow. I hope that the centre will not be a symbolic measure but will produce real solutions and offer real opportunities for us to take forward the health improvement debate in the Glasgow area.

I should say that this problem not only afflicts Glasgow in particular but affects many other parts of Scotland. We know for a fact that our diet, lack of exercise and level of smoking and alcohol abuse all contribute to the level of poor health that is one of the country's worst national embarrassments. As we tackle the problem, we need to take people with us and stay with the issue for the long term. We must improve the country's health not only by improving health treatment but by improving individual health and by ensuring that people look after themselves.

Murdo Fraser (Conservative, Mid Scotland and Fife)

To ask the First Minister whether the Scottish Executive is satisfied with the growth of the Scottish economy. (S2F-857)

Jack McConnell (Labour, Motherwell and Wishaw)

Over the past year, the Scottish economy has shown one of the best growth performances in Europe. The labour market is strong and inflation is low. However, we must do more, which is why our top priority is to encourage conditions for higher growth in Scotland and why we are investing record amounts in skills and training and in transport and other infrastructure.

Murdo Fraser (Conservative, Mid Scotland and Fife)

Even the Executive's recalibrated growth figures, which came out last week, show that Scotland's growth continues to lag behind that of the UK as a whole. Given that we have now had five years of the Executive's economic policies and five years of consistent economic underperformance, what policy changes will the First Minister introduce to turn round that serial underperformance?

Jack McConnell (Labour, Motherwell and Wishaw)

Murdo Fraser should be accurate. After all, the recent figures show that for the past two years growth in gross domestic product in Scotland has been ahead of such growth elsewhere in the UK. The fact that the rest of the UK might have been catching up with us in the last quarter of 2003 is—I am sure—a matter of some celebration for them. However, it poses a fresh challenge for us and further policy developments will be announced over the coming months.

I should point out that the best policy changes are those that have been implemented since 1997. For example, the new deal and other initiatives have led to a dramatic drop in the level of youth unemployment and we are now investing in the roads, rail, air and ferry infrastructure that was abandoned and ignored in Scotland and the rest of the UK in the 1980s and 1990s. Because of those policy changes, we are now investing in education, skills and training in a way that ensures that Scotland can once again be the skills capital of Europe and recover from the years when the Tories left so many people on the sidelines. That is the challenge. Those policy changes are starting to work and we will stick with them.

Jim Mather (Scottish National Party, Highlands and Islands)

Will the First Minister explain how it is that, when Scotland has many positive attributes and great natural resources, the arithmetic suggests that we have continuing low levels of economic growth as a result of low productivity that is hardwired into the Scottish economy? The registrar general forecasts the loss of 270,000 economically active people by 2027.

Jack McConnell (Labour, Motherwell and Wishaw)

Jim Mather is probably the most depressed person in Scotland at the fact that growth in GDP has been higher than he thought it was over the past two years. He might need some counselling to help him, because his whole economic analysis has been based on a rather distorted version of the facts. However, in the coming months, I hope that he will see the light of day and acknowledge that, in Scotland, we need a number of important elements in our long-term plans and long-term commitment to deliver higher economic growth. We need to be part of the European Union; we need to be sure that we are in that single market, contributing to the EU but also gaining from it through thousands of jobs in Scotland. Playing around with the EU constitution in a referendum is not going to help us to achieve that. The nationalist party should think again.

We need to ensure that we have a stable UK economy underpinning our Scottish growth—a UK economy with low inflation, low interest rates and low unemployment. The macroeconomic stability that we get from being part of the United Kingdom economy is a great strength for the Scottish economy.

However, here in Scotland, we also need to have our own competitive edge. We need to invest in skills, in infrastructure, in innovation, in research and development, and in companies that can grow. And yes, we have to attract more people into Scotland to help our population to grow again. We can do all that with the powers of this Parliament—if we stick with it and are in it for the long term. Mr Mather might join us some day in doing that.

George Reid (None, Ochil)

If it is kept tight, we can have one last question.

Sylvia Jackson (Labour, Stirling)

What proposals are in place to support further education colleges and other providers to ensure that we have the skills for the various housing, transport and water infrastructure projects that are very much needed for the Scottish economy?

Jack McConnell (Labour, Motherwell and Wishaw)

Clearly, one of the significant improvements in skills and training availability in Scotland over recent years has been the substantial expansion of further education provision—both full-time and, much more important, part-time. The large number of people who are benefiting from that are finding it easier to access new opportunities in the jobs market.

However, one critical change that we need to make—to correct a fault that I strongly believe was made back in the 1980s in our schools—is to ensure that youngsters who want to choose a vocational future have the opportunity at school to start to learn the skills and trades that will benefit them and our country in the years to come. A consultation is currently under way to open up access, through schools and colleges, for young people to have those new opportunities, which have been denied to many over the past 15 or so years. That is a massive and very important change in our school and further education system. Scotland as a whole will reap real benefits from it in the years to come.

Phil Gallie (Conservative, South of Scotland)

On a point of order, Presiding Officer. In his opening comments in response to the question asked by Tommy Sheridan, the First Minister said that you would judge his answer to be within limits. Will you confirm that you have no control whatsoever over the scope of the First Minister's responses to questions, although you do have powers over members? What steps could be taken to ensure a level playing field?

George Reid (None, Ochil)

I most certainly judged the First Minister's answer to be within limits, but you are quite right, Mr Gallie—standing orders are silent on the subject of answers. On the subject of questions, standing orders make it clear that they must relate to the general responsibility of ministers. Mr Sheridan was in order—just—and so was the First Minister.

Question Time — SCOTTISH EXECUTIVE — Enterprise, Transport and Lifelong Learning

Christine May (Labour, Central Fife)

To ask the Scottish Executive what action it is taking to improve rail travel to Edinburgh. (S2O-2348)

Nicol Stephen (Liberal Democrat, Aberdeen South)

The Executive is committed to a wide range of improvements, including the Edinburgh airport link, the Stirling-Alloa-Kincardine line, the Airdrie to Bathgate link, the Borders rail line and improvements to Waverley station, such as longer platforms, which, along with the new trains, will dramatically improve the peak-time capacity of services into Edinburgh. That represents the most significant investment in rail services in Scotland's capital city since the original construction of the east coast main line.

Christine May (Labour, Central Fife)

The minister will know that, as well as welcoming the improvements to which he has just referred, I have welcomed the proposed improvements to Markinch railway station in my constituency, which have now been on the stocks—or, more accurately, on the sleepers—for some considerable time. I have shared with the minister my concerns that the public inquiry into the compulsory purchase order has been scheduled for 29 July, which is in the middle of the Fife fair fortnight. So that my constituents do not think that the Executive has something to hide, will the minister reassure me that the date of the inquiry will be moved?

Nicol Stephen (Liberal Democrat, Aberdeen South)

I have taken up Christine May's concerns and she will be pleased to hear that, although the decision is not for me to take, the public local inquiry is now likely to take place on 19 or 26 August, depending on the availability of the parties involved. I am pleased that that adjustment has been made as a result of Christine May's representations and that the project, which has been delayed for too long, is now likely to proceed more quickly. I have in front of me a long list of the benefits of the project, which include a new booking office and waiting room, a fully accessible pedestrian bridge, a new 140-space car park, a bus turning circle and taxi rank, and closed-circuit television covering platforms and the car park. I am sure that everyone in the Markinch area who uses the station will warmly welcome those improvements. Let us ensure that we get the project delivered as quickly as possible.

Roseanna Cunningham (Scottish National Party, Perth)

Those improvements are welcome, but they will amount to nothing if there are not enough trains running on the tracks. Is the minister aware of the level of concern about the Perth to Edinburgh rail link? Does he know that there is no Perth to Edinburgh train between 7.10 am and 8.50 am? Can he say, hand on heart, that that level of service is sufficient to encourage people out of their cars and on to the railways? If not, what proposals does he have to improve the service between Perth and Edinburgh?

Nicol Stephen (Liberal Democrat, Aberdeen South)

If a scheduled service is not running, that is clearly a cause for serious concern. One of the most important factors in convincing people to shift from the car to public transport is reliability. We need quality and reliability in our public transport services and that applies very much to rail services. I am happy to investigate any difficulties with the Perth to Edinburgh service, as there should not be such difficulties. We have invested in 29 new trains to increase the capacity of the services into Edinburgh and in other parts of Scotland. There are a range of significant increases in peak-time capacities, all of which are well over 20 per cent, in services such as the Edinburgh to Glasgow service, the Bathgate service, Fife services and the Dunblane service. I will write to Roseanna Cunningham about the problem that she is encountering.

Chris Ballance (Green, South of Scotland)

The minister will be aware that there are campaigns for better rail services between Lanark and Edinburgh and between East Lothian, particularly Dunbar, and Edinburgh. I have just been at a meeting—about something completely different—with a lady who asked me also to mention the campaign for a new station at East Linton. How will all the new services—including the Borders railway—be catered for by the minimal Waverley reconstruction that has been forced on the Executive?

Nicol Stephen (Liberal Democrat, Aberdeen South)

The reconstruction at Waverley station will be phased. The first phase, which we have now announced, will cost around £150 million. That is not a minimal improvement in anyone's terms. It will increase the capacity of the station from 24 trains per hour to 28 trains per hour. That increase of four trains per hour will allow us to deliver the significant new improvements that we are planning throughout the Scottish rail network—the new rail lines and the new services that I mentioned in my reply to Christine May. The Airdrie to Bathgate line, the Stirling-Alloa-Kincardine line, the Waverley line and the Edinburgh rail link will all require that additional capacity at Waverley station. That is why we have got to get moving on the reconstruction now.

John Home Robertson (Labour, East Lothian)

The minister knows about the problems that people who live in the Dunbar area are experiencing in getting trains to and from Edinburgh. Does he accept that there is a powerful case for including commuter services to Dunbar in the renewed ScotRail franchise? Will he instruct his officials to work with East Lothian Council in working up that initiative?

Nicol Stephen (Liberal Democrat, Aberdeen South)

I have discussed those issues with John Home Robertson and we had a meeting on the services to Dunbar. The retendering of the franchise is based on the existing rail network. However, we are allowing for improvements to that network and we want those improvements to be delivered. The improvements that are made will automatically be a part of the new franchise. The service that the member mentions will not be part of the core franchise that will be introduced from October, but it is possible that it will become part of the developing franchise as one of the improvements that we will make over the coming years.

We are determined to make significant improvements to rail services in Scotland. There is huge demand for improvements to the rail network and, for the first time in decades, we can respond to that demand by reopening lines, introducing new lines and reopening stations. We want to do more of that, because we want to grow the public transport network and the number of rail passengers in Scotland.

Karen Whitefield (Labour, Airdrie and Shotts)

To ask the Scottish Executive what discussions it has had with ScotRail regarding rail journey times between Glasgow and Edinburgh. (S2O-2347)

Nicol Stephen (Liberal Democrat, Aberdeen South)

As well as introducing trains every 15 minutes between the two cities and increasing peak-time capacity on the route by 37 per cent through introducing new and longer trains, the Executive is willing to discuss practical and deliverable ways of improving journey times on that vital route.

Karen Whitefield (Labour, Airdrie and Shotts)

Does the minister agree that another route, the Shotts line, is seen as the Cinderella service and that it is essential that the people of Lanarkshire have a fast service through Lanarkshire to Glasgow and Edinburgh? Does he also agree that there is a need to create transport hubs both in Lanarkshire, at Shotts, and in West Lothian, at Livingston, to allow for a properly integrated rail network and co-ordination with bus services to ensure maximum access?

Nicol Stephen (Liberal Democrat, Aberdeen South)

I would very much like to see the sort of improvements that Karen Whitefield is talking about. We need a fast, efficient and reliable service between Edinburgh and Glasgow. We also need to serve the communities between Edinburgh and Glasgow. However, some of our decisions involve a trade-off, such as new stations requiring new stops, which can slow the journey time between Edinburgh to Glasgow. For example, there will perhaps be difficult decisions concerning the number of communities that are to be served by the Airdrie to Bathgate line. The introduction of Edinburgh Park station, which has been widely welcomed, has involved trains stopping and then starting again as they move away from that station. If that was done in relation to Edinburgh to Glasgow trains, it would lead to a slowing of the journey time, albeit by just a few minutes. I would like us to get the balance right and, over the next 10 years or so, to achieve the ambition of reducing the journey time between Edinburgh and Glasgow from its current 48 minutes. I believe that that would attract more passengers and lead to greater confidence in the service.

Fiona Hyslop (Scottish National Party, Lothians)

Is the minister aware that by 2006 the Dutch will be able to travel the 51 miles between Rotterdam and Amsterdam in only 28 minutes? Will he reconcile the need for a fast link between the cities of Glasgow and Edinburgh with the need for commuting opportunities for communities such as those in West Lothian? Does he agree with Karen Whitefield's valid point that more consideration should be given to making the Shotts line into the fast line in order to allow us to open up commuting opportunities for other communities? It is vital that we have fast and regular communications between Glasgow and Edinburgh and the communities in between.

Nicol Stephen (Liberal Democrat, Aberdeen South)

Fiona Hyslop makes the point very well. I assume that the service that she is talking about is a non-stop one. I agree that we should not completely reject that kind of speed for future services, but there are important communities between Edinburgh and Glasgow and one of the key reasons for the service is to serve those communities and to enable commuters to access the two cities. The demand for such services is growing and, during the next 10 years, we will be able to serve more of those communities with good-quality and reliable rail services and to increase significantly the number of passenger journeys in Scotland. As part of that, I undertake to consider issues relating to the Shotts line and to report back to Parliament. Inevitably, those matters will be a medium to longer-term part of the aspiration of reducing the journey time between Edinburgh and Glasgow from 48 minutes.

Bristow Muldoon (Labour, Livingston)

I direct the minister's attention to another key Glasgow to Edinburgh link—the Airdrie to Bathgate line. I understand that the Executive and West Lothian Council have received the draft engineering feasibility study on the reopening of the line. Will the minister confirm that that is the current position? Does the feasibility study indicate that the reopening of the line is affordable under the Executive's budget? Will he give a clear commitment to making the resources available for further progress on the line? Will he indicate when he expects a private bill to be introduced?

Nicol Stephen (Liberal Democrat, Aberdeen South)

The timing of the private bill is a matter for the project promoter. The Executive believes that the Airdrie to Bathgate line is a sensible and deliverable project that could represent value for money. A full business case will have to be made, but I know of nothing in the draft engineering report or in any other information that has been given to me that suggests that the Airdrie to Bathgate line is anything other than a very good project that the Scottish Executive should continue to support.

Brian Monteith (Conservative, Mid Scotland and Fife)

To ask the Scottish Executive whether, in light of the report of the Scottish Affairs Committee at Westminster last week, it will make further representations to the Chancellor of the Exchequer to ensure that strip stamps are not imposed on the Scotch whisky industry. (S2O-2270)

Lewis Macdonald (Labour, Aberdeen Central)

We will continue to engage with the Treasury and the Scotch whisky industry on the proposed introduction of tax stamps in two years' time.

Brian Monteith (Conservative, Mid Scotland and Fife)

I am pleased to hear that the minister will take that position. No doubt he is aware that the Scottish Affairs Committee said of Her Majesty's Customs and Excise fraud estimates:

"For any government to introduce important measures which could have major implications for industry and employment, based on what could be inaccurate figures, might be considered precipitate to the point of being reckless."

What specific representations will he now make to convince Gordon Brown to change his mind? Will he join me in condemning those Labour MPs, such as Martin O'Neill and Anne McGuire, who voted against their constituents' interests on the basis of evidence that the Labour-dominated committee said was unconvincing?

Lewis Macdonald (Labour, Aberdeen Central)

I am sure that Brian Monteith does not expect the Scottish Executive to take the place of the UK Government in making its estimates of the fraud. No one disputes that significant levels of fraud exist in the spirits industry, hence the case for the introduction of tax stamps. The National Audit Office has taken a clear view of the estimates from the whisky industry and HM Customs and Excise. It has said that, although those estimates require further work, they are within the possible range of accuracy. In other words, although the NAO has not dismissed either set of figures, it has said that both are only a snapshot of a wide range and that much more work needs to be done. I recognise the validity of that view. Given that it is not proposed to introduce the stamps until April 2006, there is an opportunity for the NAO and the Treasury to look closely at the figures.

Jim Mather (Scottish National Party, Highlands and Islands)

What specific counter-arguments is the Scottish Executive using with the Treasury to defend the interests of the whisky industry and of Scotland in the light of the strip stamp threat?

Lewis Macdonald (Labour, Aberdeen Central)

We are talking to our colleagues in the Treasury about the economic implications of their proposals. As we have described in the chamber in the past, we are making the case that we want the Treasury to talk to the industry about how fraud can be tackled in a way that does not impose undue compliance costs on the industry. There is broad agreement about what the compliance costs might be, although there is a difference at the margins between the two estimates. We are talking to the Treasury about that. We recognise, of course, that it is for the Treasury to make a decision on the stamps, but we believe that, if it proceeds with them, it should use a mechanism that will minimise the impact on the industry. The Treasury should reach agreement with the industry about the most effective way of implementing tax stamps.

Jackie Baillie (Labour, Dumbarton)

The minister will be aware of the significant and consistent representations by my colleague John McFall MP in opposing the introduction of strip stamps. Indeed, John McFall recently facilitated a welcome meeting between the Scotch Whisky Association and the chancellor. Given that the strip stamps are awkward and difficult to work with, what progress has been made with the Treasury in considering alternatives, such as fiscal marks?

Lewis Macdonald (Labour, Aberdeen Central)

It was striking that the Scottish Affairs Committee's summary of the position identified 17 different options suggested by the industry and by people such as John McFall who are advocates for the industry. I am sure that all those suggestions will be on the table at some point in the discussions that are going forward. We will continue to work closely with the industry on those matters. It is worth acknowledging John McFall's efforts to get those arguments across at the highest level in the United Kingdom Government.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

To ask the Scottish Executive what action it is taking to support and encourage the Scotch whisky industry. (S2O-2268)